Provider Demographics
NPI:1184200800
Name:ORCHARD CARE LLC
Entity Type:Organization
Organization Name:ORCHARD CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-482-1731
Mailing Address - Street 1:145 PLUM TREE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2702
Mailing Address - Country:US
Mailing Address - Phone:314-482-1731
Mailing Address - Fax:
Practice Address - Street 1:145 PLUM TREE DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2702
Practice Address - Country:US
Practice Address - Phone:314-482-1731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORCHARD CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care