Healthcare Provider Details

I. General information

NPI: 1790782217
Provider Name (Legal Business Name): BIRCHWOOD NURSING & REHAB CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 E MIDDLE RD
NANTICOKE PA
18634-3806
US

IV. Provider business mailing address

395 E MIDDLE ROAD
NANTICOKE PA
18634-3806
US

V. Phone/Fax

Practice location:
  • Phone: 570-735-2973
  • Fax: 570-735-8420
Mailing address:
  • Phone: 570-735-2973
  • Fax: 570-735-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number026402
License Number StatePA

VIII. Authorized Official

Name: SAM KRAVETZ
Title or Position: C.F.O.
Credential:
Phone: 732-942-1344