Provider Demographics
NPI:1922405414
Name:ORCHARD SERVICES GROUP LLC
Entity Type:Organization
Organization Name:ORCHARD SERVICES GROUP LLC
Other - Org Name:M.O.S.T.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-538-7717
Mailing Address - Street 1:4231 APPLE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2801
Mailing Address - Country:US
Mailing Address - Phone:248-538-7717
Mailing Address - Fax:248-538-7717
Practice Address - Street 1:4231 APPLE VALLEY LN
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2801
Practice Address - Country:US
Practice Address - Phone:248-538-7717
Practice Address - Fax:248-538-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization