Basic Information
| Provider Information | |||||||||
| NPI: | 1275525289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIRTH CARE & FAMILY HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 152 | ||||||||
| Address2: | |||||||||
| City: | BART | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175030152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177865506 | ||||||||
| FaxNumber: | 7177865507 | ||||||||
| Practice Location | |||||||||
| Address1: | 1138 GEORGETOWN RD | ||||||||
| Address2: | |||||||||
| City: | CHRISTIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175099720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177865506 | ||||||||
| FaxNumber: | 7177865507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KETCHAM | ||||||||
| AuthorizedOfficialFirstName: | MAREN | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7177865506 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | BA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QB0400X | 0002 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Birthing |
ID Information
| ID | Type | State | Issuer | Description | 1007781850004 | 05 | PA | MEDICAID |