Healthcare Provider Details

I. General information

NPI: 1336866458
Provider Name (Legal Business Name): ORCHID AUTISM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38550 GARFIELD RD STE B
CLINTON TOWNSHIP MI
48038-3406
US

IV. Provider business mailing address

38550 GARFIELD RD STE B
CLINTON TOWNSHIP MI
48038-3406
US

V. Phone/Fax

Practice location:
  • Phone: 586-741-6208
  • Fax:
Mailing address:
  • Phone: 586-741-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SWAPNIL H. SHAH
Title or Position: CEO/OWNER
Credential:
Phone: 248-996-3336