Provider Demographics
NPI:1134678337
Name:BIRCH TREE COMMUNITIES, INC.
Entity Type:Organization
Organization Name:BIRCH TREE COMMUNITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECOVERY ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PEYTON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-315-3344
Mailing Address - Street 1:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-1589
Mailing Address - Country:US
Mailing Address - Phone:501-315-3344
Mailing Address - Fax:
Practice Address - Street 1:1718 OLD HOT SPRINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019
Practice Address - Country:US
Practice Address - Phone:501-315-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1538102223Medicaid
AR5B266Medicare PIN