Provider Demographics
NPI:1275672727
Name:EASTER SEALS UCP NC INC
Entity Type:Organization
Organization Name:EASTER SEALS UCP NC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SORRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-522-9912
Mailing Address - Street 1:716 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1851
Mailing Address - Country:US
Mailing Address - Phone:704-522-9912
Mailing Address - Fax:704-522-9914
Practice Address - Street 1:716 MARSH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1851
Practice Address - Country:US
Practice Address - Phone:704-522-9912
Practice Address - Fax:704-522-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412150Medicaid