Provider Demographics
NPI:1164132601
Name:ORCHARD SENIOR LIVING LLC
Entity Type:Organization
Organization Name:ORCHARD SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARYDES
Authorized Official - Middle Name:APOLONIO
Authorized Official - Last Name:GUEVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-618-0938
Mailing Address - Street 1:235 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3735
Mailing Address - Country:US
Mailing Address - Phone:213-618-0938
Mailing Address - Fax:855-399-4070
Practice Address - Street 1:4287 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-3023
Practice Address - Country:US
Practice Address - Phone:909-399-4070
Practice Address - Fax:855-284-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility