Evergreen Road Facility

NPI 1043409584 - Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities - 320600000X

NPI Details
NPI 1043409584
Enumeration Date 10/22/2007
Last Updated 10/22/2007
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name DUANE DUANE
Position CONTROLLER
Phone (252) 446-8675
Fax
Practice Location
827 EVERGREEN RD
ROCKY MOUNT NC, 27803-2426, US
Phone (252) 446-8675
Fax
Business Location
7227 LEE DEFOREST DR
COLUMBIA MD, 21046-3236, US
Phone
Fax
Toxanomy
Taxonomy Code 320600000X
License State North Carolina
License Number 064-079
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According to our database, Evergreen Road Facility NPI is 1043409584, taxonomy code is 320600000X and license number is 064-079, license state is located at North Carolina. Evergreen Road Facility physically located at 827 Evergreen Rd, Rocky Mount NC, 27803-2426. NPI Number 1033115704 has the healthcare provider type.

1043409584 NPI number is provided on an as is basis without warranty of any kind. 1043409584 is maintained by the National Plan & Provider Enumeration System. The contents of Evergreen Road Facility are for informational purposes only.