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Organization

EVERGREEN ROAD FACILITY

Active
Other names
Care Focus, Inc.
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DUANE BRICKHOUSE (CONTROLLER)
(410) 910-1489
Entity
Organization

Contact information

Practice address
827 EVERGREEN RD, ROCKY MOUNT, NC 27803-2426
(252) 446-8675
Mailing address
7227 LEE DEFOREST DR, COLUMBIA, MD 21046-3236

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
064-079
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
064-079
LICENSE
NC
05
7804569
NC
Enumeration date
10/22/2007
Last updated
10/22/2007
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