Provider Demographics
NPI:1396974986
Name:EASTER SEALS UCP NORTH CAROLINA, INC.
Entity type:Organization
Organization Name:EASTER SEALS UCP NORTH CAROLINA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, QM
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-783-8898
Mailing Address - Street 1:2315 MYRON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3344
Mailing Address - Country:US
Mailing Address - Phone:919-783-8898
Mailing Address - Fax:919-782-5486
Practice Address - Street 1:2111 NEUSE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4317
Practice Address - Country:US
Practice Address - Phone:252-636-6007
Practice Address - Fax:252-636-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty