Provider Demographics
NPI:1184621914
Name:BIRCH TREE CONVALSCENT CENTER, INC
Entity type:Organization
Organization Name:BIRCH TREE CONVALSCENT CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.P. OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:RR 2
Mailing Address - Street 2:BOX 2215
Mailing Address - City:BIRCH TREE
Mailing Address - State:MO
Mailing Address - Zip Code:65438-9215
Mailing Address - Country:US
Mailing Address - Phone:573-292-3212
Mailing Address - Fax:573-262-3471
Practice Address - Street 1:RR 2
Practice Address - Street 2:BOX 2215
Practice Address - City:BIRCH TREE
Practice Address - State:MO
Practice Address - Zip Code:65438-9215
Practice Address - Country:US
Practice Address - Phone:573-292-3212
Practice Address - Fax:573-262-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030892314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101453603Medicaid
MO265368Medicare Oscar/Certification