Provider Demographics
NPI:1790782217
Name:BIRCHWOOD NURSING & REHAB CTR
Entity Type:Organization
Organization Name:BIRCHWOOD NURSING & REHAB CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-942-1344
Mailing Address - Street 1:395 E MIDDLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-3806
Mailing Address - Country:US
Mailing Address - Phone:570-735-2973
Mailing Address - Fax:570-735-8420
Practice Address - Street 1:395 E MIDDLE RD
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-3806
Practice Address - Country:US
Practice Address - Phone:570-735-2973
Practice Address - Fax:570-735-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA026402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009420910001Medicaid
PA395651Medicare Oscar/Certification