Provider Demographics
NPI:1023498979
Name:FISHER ROAD GROUP HOME
Entity type:Organization
Organization Name:FISHER ROAD GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:B
Authorized Official - Last Name:STRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-884-3195
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-1115
Mailing Address - Country:US
Mailing Address - Phone:828-884-3195
Mailing Address - Fax:828-884-3102
Practice Address - Street 1:120 FISHER RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3110
Practice Address - Country:US
Practice Address - Phone:828-884-8853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSYLVANIA VOCATIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL088021320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408915Medicaid