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Organization Active NPI

Evergreen Road Facility

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Rocky Mount, NC
National Provider Identifier
1043409584
Registry record updated Oct 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
064-079 Issued in NC
Legal business name
EVERGREEN ROAD FACILITY
Practice address
827 Evergreen Rd
Rocky Mount, NC 27803-2426
Phone
(252) 446-8675
NPI assigned
Oct 22, 2007
Last updated
Oct 22, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2007

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 064-079 NC Primary

Addresses

Primary practice location

827 Evergreen Rd
Rocky Mount, NC 27803-2426

Mailing address

7227 Lee Deforest Dr
Columbia, MD 21046-3236

Other identifiers 2

IdentifierTypeStateIssuer
064-079OtherNCLICENSE
7804569MedicaidNC

Other names 1

  • Care Focus, Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
Care Focus Inc31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

Locations

827 Evergreen Rd
Rocky Mount, NC 27803
Phone (252) 446-8675

NPI Registry JSON

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193011200000",
    "number": "1043409584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 LEE DEFOREST DR",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210463236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 EVERGREEN RD",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "278032426",
            "telephone_number": "252-446-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN ROAD FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2007-10-22",
        "status": "A",
        "authorized_official_last_name": "BRICKHOUSE",
        "authorized_official_first_name": "DUANE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "410-910-1489",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "064-079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "064-079",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804569",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Care Focus, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rocky Mount, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.