Provider Demographics
NPI:1750606976
Name:EAST CAROLINA OUTREACH,INC
Entity type:Organization
Organization Name:EAST CAROLINA OUTREACH,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PAYROLL
Authorized Official - Prefix:MS
Authorized Official - First Name:MELVERNICE
Authorized Official - Middle Name:PITT
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-814-6340
Mailing Address - Street 1:1528 EVANS ST STE C3
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5312
Mailing Address - Country:US
Mailing Address - Phone:252-814-6340
Mailing Address - Fax:
Practice Address - Street 1:1528 EVANS ST STE C3
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5312
Practice Address - Country:US
Practice Address - Phone:252-814-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4055251J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251J00000XAgenciesNursing Care