Healthcare Provider Details

I. General information

NPI: 1992851331
Provider Name (Legal Business Name): JULIAN F KEITH ALCOHOL AND DRUG ABUSE TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TABERNACLE ROAD
BLACK MOUNTAIN NC
28711
US

IV. Provider business mailing address

201 TABERNACLE ROAD
BLACK MOUNTAIN NC
28711-2526
US

V. Phone/Fax

Practice location:
  • Phone: 828-669-3413
  • Fax: 828-669-3471
Mailing address:
  • Phone: 828-669-3413
  • Fax: 828-669-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KAREN BURKES
Title or Position: DIVISION DIRECTOR - DSOHF
Credential:
Phone: 919-855-4700