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General NPI Number Information
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NPI Number | 1245551530
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Entity Type | Organization
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Legal Business Name | ORCHID COMMUNITY LIVING INC
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 702 FITZGERALD PL
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City | ATLANTA
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State | GA
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Zip | 30349-1085
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Country | US
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Telephone | 404-348-4494
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Fax | 404-348-4494
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Provider Business Mailing Address
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Address Line | PO BOX 366111
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City | ATLANTA
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State | GA
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Zip | 30336-6111
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Country | US
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Telephone | 404-348-4494
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Fax | 404-348-4494
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JEAN EDDY GILLES
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Credential | M.S.
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Telephone | 404-488-6165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CLA001145
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License Number State | GA
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