MEDICARE: ORCHARD VIEW TREATMENT CENTER INC

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	101YP2500X	Professional Counselor	6401010253	MI
2	225C00000X	Rehabilitation Counselor	00099158	MI

General Provider Information

NPI Number	:	1588987283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORCHARD VIEW TREATMENT CENTER INC

Provider Business Mailing Address
First Line	:	2260 ROSEANN
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314
Country	:	US
Telephone Number	:	248-881-0010
Fax Number	:	248-881-0010

Provider Business Practice Location Address
First Line	:	2260 ROSEANN DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2724
Country	:	US
Telephone Number	:	248-881-0010
Fax Number	:	248-881-0010

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS SUSANNE MARIE BASCHAROW
Credential	:	B.A.
Telephone Number	:	248-881-0010

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	04/28/2011

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