Healthcare Provider Details

I. General information

NPI: 1437711751
Provider Name (Legal Business Name): ORCHARD COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 BEECH ORCHARD LN
UPPER MARLBORO MD
20774-8851
US

IV. Provider business mailing address

2605 BEECH ORCHARD LN
UPPER MARLBORO MD
20774-8851
US

V. Phone/Fax

Practice location:
  • Phone: 845-893-7012
  • Fax:
Mailing address:
  • Phone: 845-893-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA ETTI
Title or Position: ADMINISTRATOR/MEMBER
Credential:
Phone: 845-893-7012