Basic Information
| Provider Information | |||||||||
| NPI: | 1245736008 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIRCH MANOR HEALTHCARE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8227 CLOVERLEAF DR STE 309 | ||||||||
| Address2: | |||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211081536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107298406 | ||||||||
| FaxNumber: | 4109872430 | ||||||||
| Practice Location | |||||||||
| Address1: | 7309 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | SYKESVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217847531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443343818 | ||||||||
| FaxNumber: | 4109872430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2018 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4107298406 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.