Provider Demographics
NPI:1144376864
Name:ENVISION HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ENVISION HEALTHCARE, INC.
Other - Org Name:BARKER ROAD GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:GULATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-492-8686
Mailing Address - Street 1:490 BARKER RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-8873
Mailing Address - Country:US
Mailing Address - Phone:252-492-8686
Mailing Address - Fax:
Practice Address - Street 1:490 BARKER RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537-8873
Practice Address - Country:US
Practice Address - Phone:252-492-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-091-066320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities