Healthcare Provider Details

I. General information

NPI: 1134847254
Provider Name (Legal Business Name): ORCHID ISLE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W NORTH ST STE 2
CORTEZ CO
81321-3143
US

IV. Provider business mailing address

PO BOX 10464
HILO HI
96721-5464
US

V. Phone/Fax

Practice location:
  • Phone: 970-413-3776
  • Fax: 833-536-1752
Mailing address:
  • Phone: 970-413-3776
  • Fax: 833-536-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANN M COX
Title or Position: OWNER
Credential: APN
Phone: 970-413-3776