Provider Demographics
NPI:1659577682
Name:BURKLO HOME, INC
Entity Type:Organization
Organization Name:BURKLO HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BURKLO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:910-325-6043
Mailing Address - Street 1:416 FOXTRACE LN
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-4484
Mailing Address - Country:US
Mailing Address - Phone:910-325-6043
Mailing Address - Fax:910-401-1777
Practice Address - Street 1:416 FOXTRACE LN
Practice Address - Street 2:
Practice Address - City:HUBERT
Practice Address - State:NC
Practice Address - Zip Code:28539-4484
Practice Address - Country:US
Practice Address - Phone:910-325-6043
Practice Address - Fax:910-401-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9999999251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300869Medicaid
NC3408253Medicaid
NC8300869BMedicaid
NC3408253Medicaid
NC=========OtherTAX ID NUMBER