MEDICARE: ORION HOMES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	BH4095	AZ

General Provider Information

NPI Number	:	1033460985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORION HOMES LLC

Provider Business Mailing Address
First Line	:	8615 W KELTON LN STE 309
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-4758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 E JOAN D ARC AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-4705
Country	:	US
Telephone Number	:	602-466-3223
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MOISES PEREZ
Credential	:
Telephone Number	:	602-466-3223

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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Directions to “ORION HOMES LLC ” Practice Location

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