MEDICARE: BURKE FACILITIES II, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1053595611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURKE FACILITIES II, LLC

Provider Business Mailing Address
First Line	:	4 ONYX CT
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-2680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 ONYX CT
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-2680
Country	:	US
Telephone Number	:	919-422-8819
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MISS TENISIA BURKE
Credential	:
Telephone Number	:	919-422-8819

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	12/19/2007

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