Provider Demographics
NPI:1629439765
Name:BIRCHCREST HOLDINGS, LLC
Entity Type:Organization
Organization Name:BIRCHCREST HOLDINGS, LLC
Other - Org Name:PDI WESTLAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:C
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-765-8390
Mailing Address - Street 1:4760 RICHMOND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5978
Mailing Address - Country:US
Mailing Address - Phone:216-765-8390
Mailing Address - Fax:216-765-8392
Practice Address - Street 1:30400 DETROIT RD
Practice Address - Street 2:#30 - LOWER LEVEL
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1872
Practice Address - Country:US
Practice Address - Phone:216-765-8390
Practice Address - Fax:216-765-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)