Provider Demographics
NPI:1184048761
Name:BIRCHWOOD MEADOWS, LLC
Entity type:Organization
Organization Name:BIRCHWOOD MEADOWS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH-KELTERBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-620-8890
Mailing Address - Street 1:6510 TOWN CENTER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4822
Mailing Address - Country:US
Mailing Address - Phone:248-620-8890
Mailing Address - Fax:
Practice Address - Street 1:6510 TOWN CENTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4822
Practice Address - Country:US
Practice Address - Phone:248-620-8890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM250086017253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency