Provider Demographics
NPI:1316197304
Name:BIRCH TREE COMMUNITIES, INC
Entity Type:Organization
Organization Name:BIRCH TREE COMMUNITIES, INC
Other - Org Name:MALVERN BRANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:501-315-3344
Mailing Address - Street 1:1628 E PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-4524
Mailing Address - Country:US
Mailing Address - Phone:501-332-4437
Mailing Address - Fax:
Practice Address - Street 1:1628 E PAGE AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4524
Practice Address - Country:US
Practice Address - Phone:501-332-4437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116374726Medicaid
AR171625526Medicaid
AR171625526Medicaid