Provider Demographics
NPI:1578039509
Name:DINNI BURKE & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DINNI BURKE & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINNI
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:702-489-1264
Mailing Address - Street 1:32071 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1843
Mailing Address - Country:US
Mailing Address - Phone:702-489-1264
Mailing Address - Fax:
Practice Address - Street 1:20545 CENTER RIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3442
Practice Address - Country:US
Practice Address - Phone:702-489-1264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0254339Medicaid