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General NPI Number Information
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NPI Number | 1922405414
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Entity Type | Organization
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Legal Business Name | ORCHARD SERVICES GROUP LLC
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 4231 APPLE VALLEY LN
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2801
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Country | US
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Telephone | 248-538-7717
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Fax | 248-538-7717
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Provider Business Mailing Address
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Address Line | 4231 APPLE VALLEY LN
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2801
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Country | US
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Telephone | 248-538-7717
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Fax | 248-538-7717
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | KENDRA PACK
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Credential |
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Telephone | 248-538-7717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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