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General NPI Number Information
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NPI Number | 1952130817
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Entity Type | Organization
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Legal Business Name | ORCHARD FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 3285 KENT RD
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City | STOW
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State | OH
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Zip | 44224-4501
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Country | US
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Telephone | 330-936-9633
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Fax |
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Provider Business Mailing Address
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Address Line | 2381 PLYMOUTH LN
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44221-3642
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Country | US
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Telephone | 330-936-9633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE TATE
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Credential | APRN-CNP
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Telephone | 330-936-9633
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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