Provider Demographics
NPI:1053697771
Name:BIRCHES AT HOME, LLC
Entity type:Organization
Organization Name:BIRCHES AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOBKE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:215-793-4445
Mailing Address - Street 1:345 MAIN STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438
Mailing Address - Country:US
Mailing Address - Phone:267-933-6800
Mailing Address - Fax:267-933-6803
Practice Address - Street 1:345 MAIN STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438
Practice Address - Country:US
Practice Address - Phone:267-933-6800
Practice Address - Fax:267-933-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA21883601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA21883601Medicaid