Provider Demographics
NPI:1831244524
Name:EASTERSEALS UCP OF NC
Entity type:Organization
Organization Name:EASTERSEALS UCP OF NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-566-6040
Mailing Address - Street 1:5700 EXECUTIVE CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8833
Mailing Address - Country:US
Mailing Address - Phone:704-566-6040
Mailing Address - Fax:704-566-6050
Practice Address - Street 1:2315 MYRON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3344
Practice Address - Country:US
Practice Address - Phone:800-662-7119
Practice Address - Fax:919-782-5486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-036-068320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC150662OtherCONTRACT ID FOR PATHWAYS