Provider Demographics
NPI:1598070039
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:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NASHEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEY-ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-865-8632
Mailing Address - Street 1:5171 GLENWOOD AVE
Mailing Address - Street 2:SUITE 400
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:
Practice Address - Street 1:603 LONG ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-8810
Practice Address - Country:US
Practice Address - Phone:336-246-6504
Practice Address - Fax:336-246-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health