Healthcare Provider Details

I. General information

NPI: 1346164514
Provider Name (Legal Business Name): BURNING EMBER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BROADLANDS DR
RALEIGH NC
27604-3717
US

IV. Provider business mailing address

2017 CRAWFORD RD
RALEIGH NC
27610-5011
US

V. Phone/Fax

Practice location:
  • Phone: 919-670-8868
  • Fax:
Mailing address:
  • Phone: 919-670-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIAN BLACKMON
Title or Position: FOUNDER
Credential:
Phone: 919-670-8868