Provider Demographics
NPI:1760578124
Name:EASTERN CAROLINA CASE MANAGEMENT
Entity Type:Organization
Organization Name:EASTERN CAROLINA CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:KACZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-262-7107
Mailing Address - Street 1:5616 MAXWELL PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2966
Mailing Address - Country:US
Mailing Address - Phone:910-793-9996
Mailing Address - Fax:
Practice Address - Street 1:4620 CEDAR AVENUE
Practice Address - Street 2:SUITE 118
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4423
Practice Address - Country:US
Practice Address - Phone:910-262-7107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN CAROLINA CASE MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301324BMedicaid
NC8301324GMedicaid
NC8301324HMedicaid
NC8301324Medicaid