Healthcare Provider Details

I. General information

NPI: 1265510473
Provider Name (Legal Business Name): ORCHARD GROVE HEATHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 E EMPIRE AVE
BENTON HARBOR MI
49022-2037
US

IV. Provider business mailing address

7400 NEW LAGRANGE RD STE 100
LOUISVILLE KY
40222-4870
US

V. Phone/Fax

Practice location:
  • Phone: 269-925-0033
  • Fax: 269-925-2019
Mailing address:
  • Phone: 502-429-8062
  • Fax: 502-429-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number114150
License Number StateMI

VIII. Authorized Official

Name: ALLEN CRAIG TSCHUDI
Title or Position: MANAGING MEMBER
Credential:
Phone: 502-429-8062