Provider Demographics
NPI:1265105274
Name:BURLINESS ALLIANCE LLC
Entity type:Organization
Organization Name:BURLINESS ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TERANDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS-A
Authorized Official - Phone:252-969-0752
Mailing Address - Street 1:1857 J P RD
Mailing Address - Street 2:
Mailing Address - City:WHITAKERS
Mailing Address - State:NC
Mailing Address - Zip Code:27891-9189
Mailing Address - Country:US
Mailing Address - Phone:252-969-0752
Mailing Address - Fax:252-303-5484
Practice Address - Street 1:1857 J P RD
Practice Address - Street 2:
Practice Address - City:WHITAKERS
Practice Address - State:NC
Practice Address - Zip Code:27891-9189
Practice Address - Country:US
Practice Address - Phone:252-969-0752
Practice Address - Fax:252-303-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083255137Medicaid