MEDICARE: BURKE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310500000X	Mental Illness Intermediate Care Facility		TX

General Provider Information

NPI Number	:	1467502187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURKE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 151608
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75915-1608
Country	:	US
Telephone Number	:	936-631-6149
Fax Number	:	936-639-5837

Provider Business Practice Location Address
First Line	:	46 W BAY DR
Second Line	:
City	:	JASPER
State	:	TX
Zip	:	75951-5532
Country	:	US
Telephone Number	:	936-631-6149
Fax Number	:	936-639-5837

Authorized Official
Title or Position	:	ACCOUNTING CLERK
Name	:	DORTHEY SINGLETON
Credential	:
Telephone Number	:	936-631-6149

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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Directions to “BURKE CENTER ” Practice Location

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