Provider Demographics
NPI:1972146256
Name:THE ORCHARD AT STONE CREEK, INC.
Entity Type:Organization
Organization Name:THE ORCHARD AT STONE CREEK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-531-1381
Mailing Address - Street 1:4900 TILLMAN XING
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-4108
Mailing Address - Country:US
Mailing Address - Phone:229-531-1381
Mailing Address - Fax:
Practice Address - Street 1:4900 TILLMAN XING
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-4108
Practice Address - Country:US
Practice Address - Phone:229-531-1381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ORCHARD AT STONE CREEK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies