Provider Demographics
NPI:1497061451
Name:E SQUARED COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:E SQUARED COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-218-7161
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-0388
Mailing Address - Country:US
Mailing Address - Phone:910-814-2134
Mailing Address - Fax:910-893-4731
Practice Address - Street 1:231 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5430
Practice Address - Country:US
Practice Address - Phone:910-814-2134
Practice Address - Fax:910-893-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301695Medicaid
NC8303123Medicaid
NC8303123VMedicaid