Organization Name: | EVERGREEN ROAD FACILITY |
NPI Number: | 1043409584 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DUANE BRICKHOUSE (CONTROLLER) |
Mailing Address: | 827 Evergreen Rd Rocky Mount |
State: | NC US |
Postal Code: | 278032426 |
Phone Number: | 2524468675 |
Fax Number: | |
NPI Enumeration Date: | 10/22/2007 |
NPI Last Update Date: | 10/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | 064-079 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |