Provider Demographics
NPI:1295312221
Name:ORCHARD WELLNESS, LLC
Entity type:Organization
Organization Name:ORCHARD WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, ABPP
Authorized Official - Phone:847-877-9578
Mailing Address - Street 1:9444 KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1443
Mailing Address - Country:US
Mailing Address - Phone:847-877-9578
Mailing Address - Fax:
Practice Address - Street 1:9444 KEELER AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1443
Practice Address - Country:US
Practice Address - Phone:847-877-9578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health