Healthcare Provider Details

I. General information

NPI: 1114077724
Provider Name (Legal Business Name): BURKE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CUNNINGHAM
LUFKIN TX
75901
US

IV. Provider business mailing address

PO BOX 151608
LUFKIN TX
75915-1608
US

V. Phone/Fax

Practice location:
  • Phone: 936-634-2422
  • Fax: 936-639-5837
Mailing address:
  • Phone: 936-631-6149
  • Fax: 936-639-5837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: DORTHEY SINGLETON
Title or Position: ACCOUNTING CLERK
Credential:
Phone: 936-631-6149