Provider Demographics
NPI:1366188278
Name:THE ORENDA CENTER FOR WELLNESS LLC
Entity type:Organization
Organization Name:THE ORENDA CENTER FOR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-573-0686
Mailing Address - Street 1:17645 HARBAUGH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SABILLASVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21780-9616
Mailing Address - Country:US
Mailing Address - Phone:301-241-3629
Mailing Address - Fax:240-366-1851
Practice Address - Street 1:3619 BUCKEYSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:BUCKEYSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21717
Practice Address - Country:US
Practice Address - Phone:301-241-3629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1134774755Medicaid
MD1154984961Medicaid
MD1467002543Medicaid