Provider Demographics
NPI:1518566751
Name:R. J. BLACKLEY ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Entity Type:Organization
Organization Name:R. J. BLACKLEY ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Other - Org Name:R.J. BLACKLEY ADATC OUTPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-855-4700
Mailing Address - Street 1:100 W H ST
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-1605
Mailing Address - Country:US
Mailing Address - Phone:919-575-7928
Mailing Address - Fax:919-575-7260
Practice Address - Street 1:100 W H ST
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1605
Practice Address - Country:US
Practice Address - Phone:919-575-7928
Practice Address - Fax:919-575-7260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R. J. BLACKLEY ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-20
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health