Provider Demographics
NPI:1124465398
Name:BIRCH PSYCHIATRIC SERVICES A NURSING CORPORATION
Entity type:Organization
Organization Name:BIRCH PSYCHIATRIC SERVICES A NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:510-599-9421
Mailing Address - Street 1:2397 SHATTUCK AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1567
Mailing Address - Country:US
Mailing Address - Phone:510-599-9421
Mailing Address - Fax:
Practice Address - Street 1:2397 SHATTUCK AVE STE 206
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1567
Practice Address - Country:US
Practice Address - Phone:510-599-9421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18162363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACY849ZMedicare PIN