Provider Demographics
NPI:1083951180
Name:ORCHARD ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:ORCHARD ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-254-7874
Mailing Address - Street 1:23023 ORCHARD LAKE RD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17352 W 12 MILE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2119
Practice Address - Country:US
Practice Address - Phone:248-254-7874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care