MEDICARE: BIRCHWOOD SUITES OPERATOR LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1578285318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRCHWOOD SUITES OPERATOR LLC

Provider Business Mailing Address
First Line	:	35 SUTTON PL
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1429
Country	:	US
Telephone Number	:	516-896-1196
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 CLAY PITTS RD
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-3801
Country	:	US
Telephone Number	:	631-368-5252
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. BRIAN ROSENMAN
Credential	:
Telephone Number	:	516-896-1196

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	09/19/2022

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