Provider Demographics
NPI:1043683055
Name:THE BURKE CENTER, INC.
Entity Type:Organization
Organization Name:THE BURKE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:BCM
Authorized Official - Phone:570-240-4774
Mailing Address - Street 1:70 HOLLOW CREST RD
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-9507
Mailing Address - Country:US
Mailing Address - Phone:570-240-4774
Mailing Address - Fax:570-836-6888
Practice Address - Street 1:70 HOLLOW CREST RD
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-9507
Practice Address - Country:US
Practice Address - Phone:570-240-4774
Practice Address - Fax:570-836-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA576731OtherMEDICARE
PA102920597001Medicaid