MEDICARE: BURKE HOSPICE AND PALLIATIVE CARE, INC.

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	251G00000X	Community Based Hospice Care Agency	HOS0364	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942262639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURKE HOSPICE AND PALLIATIVE CARE, INC.

Provider Business Mailing Address
First Line	:	1721 ENON RD
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-9314
Country	:	US
Telephone Number	:	828-879-1601
Fax Number	:	828-879-3500

Provider Business Practice Location Address
First Line	:	1721 ENON RD
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-9314
Country	:	US
Telephone Number	:	828-879-1601
Fax Number	:	828-879-3500

Authorized Official
Title or Position	:	CEO
Name	:	MR. RON LASALLE
Credential	:	RN BSN MBA
Telephone Number	:	828-879-1601

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	08/22/2020

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