Organization
EASTER SEALS UCP NC & VA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT BEAVERS (CREDENTIALING MANAGER)
(919) 783-8898
Entity
Organization
Contact information
Practice address
600 LYNNDALE CT, SUITE F, GREENVILLE, NC 27858-5443
(252) 353-7923
(252) 353-8001
Mailing address
5171 GLENWOOD AVE, SUITE 400, RALEIGH, NC 27612-3266
(919) 783-8898
(919) 782-5486
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300473B
—
NC
05
—
8300473G
—
NC
05
—
8300473H
—
NC
Enumeration date
01/22/2007
Last updated
11/01/2021
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