Healthcare Provider Details

I. General information

NPI: 1093187577
Provider Name (Legal Business Name): ORCHARD AFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 ORCHARD STREET
ECORSE MI
48229
US

IV. Provider business mailing address

73 ORCHARD STREET
ECORSE MI
48229
US

V. Phone/Fax

Practice location:
  • Phone: 734-512-6294
  • Fax: 313-722-4747
Mailing address:
  • Phone: 734-512-6264
  • Fax: 313-722-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ANGELLA P HAMM
Title or Position: DIRECTOR
Credential: CNA
Phone: 734-512-6294