Healthcare Provider Details

I. General information

NPI: 1104202688
Provider Name (Legal Business Name): ORCHARD VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7660 GROSS POINT RD
SKOKIE IL
60077-2613
US

IV. Provider business mailing address

7660 GROSS POINT RD
SKOKIE IL
60077-2613
US

V. Phone/Fax

Practice location:
  • Phone: 630-803-4983
  • Fax:
Mailing address:
  • Phone: 630-803-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARLENE HODGES
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 847-967-1800