Provider Demographics
| NPI: | 1477646081 |
|---|---|
| Name: | EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC. |
| Entity Type: | Organization |
| Organization Name: | EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR, CONTRACTS & CREDENTIALING |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JELORE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | LITTLE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 336-545-6338 |
| Mailing Address - Street 1: | 5171 GLENWOOD AVE |
| Mailing Address - Street 2: | STE 211 |
| Mailing Address - City: | RALEIGH |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 27612-3266 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 919-783-8898 |
| Mailing Address - Fax: | 919-782-5486 |
| Practice Address - Street 1: | 4000 WAKE FOREST ROAD |
| Practice Address - Street 2: | SUITE 200 |
| Practice Address - City: | RALEIGH |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27609 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 919-861-1600 |
| Practice Address - Fax: | 919-861-1637 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-10-02 |
| Last Update Date: | 2018-10-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 251B00000X | Agencies | Case Management | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 251F00000X | Agencies | Home Infusion | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
| No | 261QH0700X | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
| No | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
| No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
| No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |
