Provider Demographics
NPI:1992851331
Name:JULIAN F KEITH ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Entity Type:Organization
Organization Name:JULIAN F KEITH ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Other - Org Name:JFK ADATC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIVISION DIRECTOR - DSOHF
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 1:201 TABERNACLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2526
Mailing Address - Country:US
Mailing Address - Phone:828-669-3413
Mailing Address - Fax:828-669-3471
Practice Address - Street 1:201 TABERNACLE ROAD
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711
Practice Address - Country:US
Practice Address - Phone:828-669-3413
Practice Address - Fax:828-669-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404023Medicaid
NC3404023Medicaid