Healthcare Provider Details

I. General information

NPI: 1952558868
Provider Name (Legal Business Name): BURKE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 FM 150 W
DRIFTWOOD TX
78619-9202
US

IV. Provider business mailing address

PO BOX 40
DRIFTWOOD TX
78619-0040
US

V. Phone/Fax

Practice location:
  • Phone: 512-858-4258
  • Fax:
Mailing address:
  • Phone: 512-858-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: KARYN ROGERS
Title or Position: SHELTER DIRECTOR
Credential:
Phone: 512-858-4258