Active NPI
Kathleen Sue Burke
- Mental Illness Community Based Residential Treatment Facility
- Montrose, MI
National Provider Identifier
1316198260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- AF 250247793
- Practice address
- 138 Washington
Montrose, MI 48457-7719 - Phone
- (810) 639-4520
- NPI assigned
- Oct 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | AF 250247793 | MI | Primary |
Addresses
Primary practice location
138 Washington
Montrose, MI 48457-7719
Mailing address
138 Washington
P.O. Box 575
Montrose, MI 48457-7719
Phone (810) 639-4520
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9182961 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AF 250247793 | MI | MD | Mental Illness Community Based Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223424000000",
"number": "1316198260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 WASHINGTON",
"address_2": "P.O. BOX 575",
"city": "MONTROSE",
"state": "MI",
"postal_code": "484577719",
"telephone_number": "810-639-4520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 WASHINGTON",
"city": "MONTROSE",
"state": "MI",
"postal_code": "484577719",
"telephone_number": "810-639-4520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURKE",
"first_name": "KATHLEEN",
"middle_name": "SUE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-08",
"last_updated": "2008-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "MI",
"license": "AF 250247793",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9182961",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montrose, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.