Provider Demographics
NPI:1467002543
Name:THE ORENDA CENTER FOR WELLNESS LLC
Entity Type:Organization
Organization Name:THE ORENDA CENTER FOR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:013-573-0686
Mailing Address - Street 1:17645 HARBAUGH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SABILLASVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21780-9616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7540 N MARKET ST UNIT A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4307
Practice Address - Country:US
Practice Address - Phone:240-831-4873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD201110265Medicaid