Provider Demographics
NPI:1235429838
Name:E SQUARED COMMUNITY SERVICES, LLC
Entity type:Organization
Organization Name:E SQUARED COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-218-7161
Mailing Address - Street 1:5022 ISABELLA CANNON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4804
Mailing Address - Country:US
Mailing Address - Phone:919-218-7161
Mailing Address - Fax:919-327-6813
Practice Address - Street 1:101 INDUSTRIAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2307
Practice Address - Country:US
Practice Address - Phone:919-340-1677
Practice Address - Fax:919-340-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301695Medicaid