Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Intellectual & Developmental Disabilities |
103TM1800X | 62 | Psychologist, Clinical |
| NPI Number | 1811423486 |
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| LBN Legal business name | ORCHARD ASSISTED LIVING | ||||
| Authorized official | JESSICA FULTON - (OWNER, ADMINISTRATOR) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 05/02/2017 | ||||
| Last updated | 05/02/2017 - About 9 years ago | ||||
| Identifiers |
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