=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295027795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PBORCHARD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2011
-----------------------------------------------------
Last Update Date | 05/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 WOODS POINT ROAD
-----------------------------------------------------
City | BLUE HILL
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-374-5721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 997
-----------------------------------------------------
City | BLUE HILL
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04614-0997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-374-5721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. PATRICIA BROWN ORCHARD
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 207-374-5721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC12181
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------