NPIMap

Organization Active NPI

Easter Seals Ucp NC & VA, Inc.

  • Community/Behavioral Health Agency
  • Greenville, NC
National Provider Identifier
1770637407
Registry record updated Nov 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EASTER SEALS UCP NC & VA, INC.
Practice address
600 Lynndale CT
Suite F
Greenville, NC 27858-5443
Phone
(252) 353-7923
Fax
(252) 353-8001
NPI assigned
Jan 22, 2007
Last updated
Nov 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brett Beavers
Title
Credentialing Manager
Phone
(919) 783-8898

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

600 Lynndale CT
Suite F
Greenville, NC 27858-5443

Mailing address

5171 Glenwood Ave
Suite 400
Raleigh, NC 27612-3266
Phone (919) 783-8898

Other practice location 1

912 Academy St
Ahoskie, NC 27910-9591
Phone (252) 513-8168

Other practice location 2

306 Church St
Morehead City, NC 28557-3390
Phone (919) 783-8898

Other practice location 3

904 W Ehringhaus St Ste 6
Elizabeth City, NC 27909-6947
Phone (252) 562-6221

Other identifiers 3

IdentifierTypeStateIssuer
8300473GMedicaidNC
8300473HMedicaidNC
8300473BMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101105000534 NC Part B Supplier - Clinic/Group Practice 7618161407 Receives reassigned benefits from 79 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Raleigh, NC; Jacksonville, NC; New Bern, NC; Nags Head, NC; Mount Airy, NC; Morganton, NC; Morehead City, NC; Kinston, NC…

National Provider Directory

National Provider Directory
Tax ID family
Easter Seals Ucp North Carolina224 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

103 Loftin Ln
Ahoskie, NC 27910

912 Academy St
Ahoskie, NC 27910
Phone (252) 513-8168

600 Lynndale Ct
Ste F
Greenville, NC 27858
Phone (252) 353-8001

414 W Lebanon St
Mount Airy, NC 27030
Phone (336) 789-9041

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635724800000",
    "number": "1770637407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5171 GLENWOOD AVE",
            "address_2": "SUITE 400",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123266",
            "telephone_number": "919-783-8898",
            "fax_number": "919-782-5486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 LYNNDALE CT",
            "address_2": "SUITE F",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585443",
            "telephone_number": "252-353-7923",
            "fax_number": "252-353-8001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "912 Academy St",
            "address_purpose": "LOCATION",
            "city": "AHOSKIE",
            "state": "NC",
            "postal_code": "279109591",
            "country_code": "US",
            "telephone_number": "252-513-8168",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "306 Church St",
            "address_purpose": "LOCATION",
            "city": "Morehead City",
            "state": "NC",
            "postal_code": "285573390",
            "country_code": "US",
            "telephone_number": "919-783-8898",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "904 W Ehringhaus St Ste 6",
            "address_purpose": "LOCATION",
            "city": "Elizabeth City",
            "state": "NC",
            "postal_code": "279096947",
            "country_code": "US",
            "telephone_number": "252-562-6221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EASTER SEALS UCP NC & VA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2021-11-01",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "BEAVERS",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "919-783-8898"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300473G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300473H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300473B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.