Provider Demographics
NPI:1316397847
Name:BURKE COUNCIL ON ALCOHOLISM AND CHEMICAL DEPENDENCY, INC
Entity Type:Organization
Organization Name:BURKE COUNCIL ON ALCOHOLISM AND CHEMICAL DEPENDENCY, INC
Other - Org Name:BURKE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-433-1221
Mailing Address - Street 1:203 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3417
Mailing Address - Country:US
Mailing Address - Phone:828-433-1221
Mailing Address - Fax:828-433-1287
Practice Address - Street 1:1013 WEST AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5126
Practice Address - Country:US
Practice Address - Phone:828-433-1221
Practice Address - Fax:828-433-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-012-038101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006610Medicaid