MEDICARE: BIRCH TREE HOME SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1639621030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRCH TREE HOME SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 1409
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-6409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5076 KEEFER LN
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-7934
Country	:	US
Telephone Number	:	614-634-6505
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	BENJAMIN D'ANGELO
Credential	:
Telephone Number	:	614-333-6667

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	11/01/2016

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