Provider Demographics
NPI:1518108430
Name:EPIC SUPPORTS AND SERVICES
Entity Type:Organization
Organization Name:EPIC SUPPORTS AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTINE
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-341-2397
Mailing Address - Street 1:602 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8508
Mailing Address - Country:US
Mailing Address - Phone:252-341-2397
Mailing Address - Fax:
Practice Address - Street 1:99 N MAIN ST
Practice Address - Street 2:2ND FLOOR OFFICE #1
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5056
Practice Address - Country:US
Practice Address - Phone:252-641-1620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health