=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326430885
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORCHARD HILL ENTERPRISES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2015
-----------------------------------------------------
Last Update Date | 02/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9620 JOUPPI RD
-----------------------------------------------------
City | KALEVA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49645-9313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-362-3629
-----------------------------------------------------
Fax | 231-362-3635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9620 JOUPPI RD
-----------------------------------------------------
City | KALEVA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49645-9313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-362-3629
-----------------------------------------------------
Fax | 231-362-3635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MISS LORRAINE MARIE BASIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 231-510-1736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | AS510238102
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------