Provider Demographics
NPI:1558414466
Name:EZCARE PROVIDERS INC.
Entity Type:Organization
Organization Name:EZCARE PROVIDERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:OKORO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:336-638-6634
Mailing Address - Street 1:PO BOX 21743
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27420-1743
Mailing Address - Country:US
Mailing Address - Phone:336-638-6634
Mailing Address - Fax:336-638-5994
Practice Address - Street 1:4202 SCOTNEY DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7558
Practice Address - Country:US
Practice Address - Phone:336-638-6634
Practice Address - Fax:336-638-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-046-762322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604017Medicaid