Provider Demographics
NPI:1073284147
Name:ORCHID ASSISTED LIVING SERVICE INC.
Entity Type:Organization
Organization Name:ORCHID ASSISTED LIVING SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIRAHMAN
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-404-8682
Mailing Address - Street 1:15965 ELMWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4250
Mailing Address - Country:US
Mailing Address - Phone:612-404-8682
Mailing Address - Fax:
Practice Address - Street 1:15965 ELMWOOD WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4250
Practice Address - Country:US
Practice Address - Phone:612-404-8682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251J00000XAgenciesNursing Care