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General NPI Number Information
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NPI Number | 1144613092
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Entity Type | Organization
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Legal Business Name | BURKE FAMILY CARE, LLC
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 11000B JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-2747
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Country | US
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Telephone | 757-262-7677
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 69001
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City | HAMPTON
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State | VA
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Zip | 23669-9301
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Country | US
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Telephone | 757-262-7677
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Fax | 757-224-4686
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Authorized Official
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Title or Position | CAO
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Name | MICHAEL BURKE JR.
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Credential |
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Telephone | 757-262-7577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 1033
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License Number State | VA
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