Organization
EASTER SEALS UCP NORTH CAROLINA & VIRGIINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT BEAVERS (CREDENTIALING MANAGER)
(919) 210-7661
Entity
Organization
Contact information
Practice address
1410 COMMONWEALTH DR STE 103A, WILMINGTON, NC 28403-0377
(910) 790-5921
(910) 794-1036
Mailing address
5171 GLENWOOD AVE, SUITE 400, RALEIGH, NC 27612-3266
(919) 783-8898
(919) 782-5486
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253J00000X
Foster Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301006A
—
NC
05
—
8301006B
—
NC
05
—
8301006G
—
NC
05
—
8301006H
—
NC
05
—
8301006I
—
NC
05
—
8303044
—
NC
05
—
8303044A
—
NC
Enumeration date
01/22/2007
Last updated
03/23/2022
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