Healthcare Provider Details

I. General information

NPI: 1467002543
Provider Name (Legal Business Name): THE ORENDA CENTER FOR WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 N MARKET ST UNIT A
FREDERICK MD
21701-4307
US

IV. Provider business mailing address

17645 HARBAUGH VALLEY RD
SABILLASVILLE MD
21780-9616
US

V. Phone/Fax

Practice location:
  • Phone: 240-831-4873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELSEA KEPHART
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 13-573-0686