NPI 1043409584

Evergreen Road Facility

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Rocky Mount, NC

Practice location

Address: 827 Evergreen Rd, Rocky Mount, NC 27803-2426
Phone: (252) 446-8675
Mailing address: 7227 Lee Deforest Dr, Columbia, MD 21046-3236

Authorised official

Name: Duane Brickhouse
Title: Controller
Phone: (410) 910-1489

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 064-079 (NC)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in North Carolina →

Registry record

NPI: 1043409584
Entity type: Organization
NPI issued: 22 Oct 2007
Record last updated: 22 Oct 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.