Provider Demographics
NPI:1811423486
Name:ORCHARD ASSISTED LIVING
Entity Type:Organization
Organization Name:ORCHARD ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:TIARA
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-306-4173
Mailing Address - Street 1:400 W 76TH AVE
Mailing Address - Street 2:#105
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2551
Mailing Address - Country:US
Mailing Address - Phone:907-306-4173
Mailing Address - Fax:
Practice Address - Street 1:400 W 76TH AVE
Practice Address - Street 2:#105
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2551
Practice Address - Country:US
Practice Address - Phone:907-306-4173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101114103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty