Healthcare Provider Details

I. General information

NPI: 1063924090
Provider Name (Legal Business Name): ORION HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4635 W ASTER DR
GLENDALE AZ
85304-2126
US

IV. Provider business mailing address

15396 N 83RD AVE STE A303
PEORIA AZ
85381-5625
US

V. Phone/Fax

Practice location:
  • Phone: 602-466-3223
  • Fax: 602-441-3981
Mailing address:
  • Phone: 602-466-3223
  • Fax: 602-441-3981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH5255
License Number StateAZ

VIII. Authorized Official

Name: BRANDON DOW
Title or Position: COO
Credential:
Phone: 602-466-3223