Basic Information
| Provider Information | |||||||||
| NPI: | 1003801093 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BIRCHWOOD PLAZA INC. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1426 W BIRCHWOOD AVE | ||||||||
| Address2: | 1426 W. BIRCHWOOD AVE. | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606261807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732744405 | ||||||||
| FaxNumber: | 7732744412 | ||||||||
| Practice Location | |||||||||
| Address1: | 1426 W BIRCHWOOD AVE | ||||||||
| Address2: | 1426 W. BIRCHWOOD AVE. | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606261807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732744405 | ||||||||
| FaxNumber: | 7732744412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 11/07/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCHIFFMAN | ||||||||
| AuthorizedOfficialFirstName: | ABRAHAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7732744405 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0028696 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.