1316397847 NPI number — BURKE COUNCIL ON ALCOHOLISM AND CHEMICAL DEPENDENCY, INC

Table of content: (NPI 1316397847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316397847 NPI number — BURKE COUNCIL ON ALCOHOLISM AND CHEMICAL DEPENDENCY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURKE COUNCIL ON ALCOHOLISM AND CHEMICAL DEPENDENCY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316397847
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 WHITE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655-3417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-433-1221
Provider Business Mailing Address Fax Number:
828-433-1287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 WEST AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-433-1221
Provider Business Practice Location Address Fax Number:
828-433-1287
Provider Enumeration Date:
06/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MARKS
Authorized Official First Name:
JOE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
828-433-1221

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  MHL-012-038 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6006610 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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