EVERGREEN ROAD FACILITY NPI 1043409584

NPI Information

NPI: 1043409584
Provider Name: EVERGREEN ROAD FACILITY

Other Name: CARE FOCUS, INC.

Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320600000X
Entity Type: Organization
Address:
827 EVERGREEN RD
ROCKY MOUNT, NC
ZIP 27803
Phone: (252) 446-8675
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EVERGREEN ROAD FACILITY is a residential treatment facility, intellectual and/or developmental disabilities in Rocky Mount, NC. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. EVERGREEN ROAD FACILITY NPI is 1043409584. The provider is registered as an organization entity type.
The provider Other Name Is Care Focus, Inc..

The provider's business location address is:

827 EVERGREEN RD
ROCKY MOUNT, NC
ZIP 27803-426
Phone: (252) 446-8675

The provider's authorized official is Duane Brickhouse .
The authorized official title is Controller and has the following contact phone number (410) 910-1489.

The enumeration date for this NPI number is 10/22/2007 and was last updated on 10/22/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities		064-079	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7804569	MEDICAID	NORTH CAROLINA
2	064-079	OTHER	NORTH CAROLINA	LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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