Provider Demographics
NPI:1619110582
Name:EASTER SEALS UCP NORTH CAROLINA
Entity Type:Organization
Organization Name:EASTER SEALS UCP NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:GERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-538-4191
Mailing Address - Street 1:3801 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 320
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-2934
Mailing Address - Country:US
Mailing Address - Phone:919-538-4191
Mailing Address - Fax:919-256-0781
Practice Address - Street 1:33 DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1343
Practice Address - Country:US
Practice Address - Phone:910-790-5921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health