Provider Demographics
NPI:1205126539
Name:BIRCH TREE COMMUNITIES, INC.
Entity type:Organization
Organization Name:BIRCH TREE COMMUNITIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:501-303-1634
Mailing Address - Street 1:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-1589
Mailing Address - Country:US
Mailing Address - Phone:501-303-1634
Mailing Address - Fax:501-303-1676
Practice Address - Street 1:1718 OLD HOT SPRINGS HWY
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019
Practice Address - Country:US
Practice Address - Phone:501-303-1634
Practice Address - Fax:501-303-1676
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIRCH TREE COMMUNITIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-07
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130686OtherPK
AR187622407Medicaid
6613980001Medicare NSC