Healthcare Provider Details

I. General information

NPI: 1467794594
Provider Name (Legal Business Name): ORION HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12414 N 44TH AVE
GLENDALE AZ
85304-2304
US

IV. Provider business mailing address

12414 N 44TH AVE
GLENDALE AZ
85304-2304
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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