Provider Demographics
NPI:1902119118
Name:ORCHARD PLACE
Entity Type:Organization
Organization Name:ORCHARD PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR GENERALIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-246-3508
Mailing Address - Street 1:2116 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:808 5TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1307
Practice Address - Country:US
Practice Address - Phone:515-244-2267
Practice Address - Fax:515-244-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA236323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0299297Medicaid