Provider Demographics
NPI:1356554059
Name:ORCHARDS CHILDREN'S SERVICES, INC.
Entity type:Organization
Organization Name:ORCHARDS CHILDREN'S SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LUSKO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:248-258-0440
Mailing Address - Street 1:24901 NORTHWESTERN HWY STE 500
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2212
Mailing Address - Country:US
Mailing Address - Phone:248-258-0044
Mailing Address - Fax:248-258-0458
Practice Address - Street 1:24901 NORTHWESTERN HWY STE 500
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2212
Practice Address - Country:US
Practice Address - Phone:248-258-0440
Practice Address - Fax:248-258-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3471170Medicaid