Provider Demographics
NPI:1932536752
Name:ORCHID HOUSE LLC
Entity Type:Organization
Organization Name:ORCHID HOUSE LLC
Other - Org Name:ORCHID HOUSE HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:V
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-872-0402
Mailing Address - Street 1:1954 PLACENTIA AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3459
Mailing Address - Country:US
Mailing Address - Phone:949-872-0402
Mailing Address - Fax:
Practice Address - Street 1:3730 RAMONA DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-4733
Practice Address - Country:US
Practice Address - Phone:949-872-0402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)