Healthcare Provider Details

I. General information

NPI: 1194727388
Provider Name (Legal Business Name): ORCHARD LAKE INVESTMENTS ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WEST WALLACE
ASHLEY MI
48806-0127
US

IV. Provider business mailing address

PO BOX 127
ASHLEY MI
48806-0127
US

V. Phone/Fax

Practice location:
  • Phone: 989-847-2011
  • Fax: 989-847-3422
Mailing address:
  • Phone: 989-847-2011
  • Fax: 989-847-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number29-4030
License Number StateMI

VIII. Authorized Official

Name: MR. DANIEL ABRAMSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 248-539-8200