Provider Demographics
NPI:1720375033
Name:BIRCH HAVEN SENIOR LIVING, INC.
Entity Type:Organization
Organization Name:BIRCH HAVEN SENIOR LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-631-4100
Mailing Address - Street 1:218 22ND AVE W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1021
Mailing Address - Country:US
Mailing Address - Phone:715-292-6444
Mailing Address - Fax:715-292-6446
Practice Address - Street 1:218 22ND AVE W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1021
Practice Address - Country:US
Practice Address - Phone:715-292-6444
Practice Address - Fax:715-292-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00137753104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness