Healthcare Provider Details

I. General information

NPI: 1770032971
Provider Name (Legal Business Name): BIRCH TREE COMMUNITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 OLD HOT SPRINGS HIGHWAY
BENTON AR
72019
US

IV. Provider business mailing address

PO BOX 1589
BENTON AR
72018-1589
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-3344
  • Fax:
Mailing address:
  • Phone: 501-315-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateAR

VIII. Authorized Official

Name: STACIA D LUTON
Title or Position: RECOVERY ASSISTANT
Credential:
Phone: 501-818-0325