Provider Demographics
NPI:1619729415
Name:BIRCH GROVE MENTAL HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:BIRCH GROVE MENTAL HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-835-3214
Mailing Address - Street 1:406 JACKINS SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:HODGDON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-4332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 COURT ST STE 2
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1746
Practice Address - Country:US
Practice Address - Phone:207-835-3214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty