Provider Demographics
NPI:1245771682
Name:ORCHID MANOR PERSONAL CARE HOME, INC.
Entity Type:Organization
Organization Name:ORCHID MANOR PERSONAL CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NAEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-402-0639
Mailing Address - Street 1:312 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2033
Mailing Address - Country:US
Mailing Address - Phone:229-405-3932
Mailing Address - Fax:229-405-3932
Practice Address - Street 1:312 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2033
Practice Address - Country:US
Practice Address - Phone:229-405-3932
Practice Address - Fax:229-405-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility