Provider Demographics
NPI:1225396013
Name:EASTER SEALS UCP
Entity Type:Organization
Organization Name:EASTER SEALS UCP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-783-8898
Mailing Address - Street 1:2260 S CHURCH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5390
Mailing Address - Country:US
Mailing Address - Phone:336-585-1737
Mailing Address - Fax:
Practice Address - Street 1:2260 S CHURCH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5390
Practice Address - Country:US
Practice Address - Phone:336-585-1737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health