Healthcare Provider Details

I. General information

NPI: 1083951180
Provider Name (Legal Business Name): ORCHARD ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17352 W 12 MILE RD SUITE 210
SOUTHFIELD MI
48076-2119
US

IV. Provider business mailing address

23023 ORCHARD LAKE RD BUILDING C
FARMINGTON MI
48336-3209
US

V. Phone/Fax

Practice location:
  • Phone: 248-254-7874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATHAN MAZUR
Title or Position: PRESIDENT
Credential:
Phone: 248-254-7874