Healthcare Provider Details

I. General information

NPI: 1184200800
Provider Name (Legal Business Name): ORCHARD CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PLUM TREE DR
SAINT PETERS MO
63376-2702
US

IV. Provider business mailing address

145 PLUM TREE DR
SAINT PETERS MO
63376-2702
US

V. Phone/Fax

Practice location:
  • Phone: 314-482-1731
  • Fax:
Mailing address:
  • Phone: 314-482-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE WADE
Title or Position: OWNER
Credential:
Phone: 314-482-1731