1043662893 NPI number — OPEN ARMS HOME HEALTH CARE - COUNCIL BLUFFS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043662893 NPI number — OPEN ARMS HOME HEALTH CARE - COUNCIL BLUFFS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN ARMS HOME HEALTH CARE - COUNCIL BLUFFS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043662893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16670 FRANKLIN TRL SE
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
PRIOR LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55372-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-447-2345
Provider Business Mailing Address Fax Number:
952-447-2344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2306 SHERWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51503-1048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-447-2345
Provider Business Practice Location Address Fax Number:
952-447-2344
Provider Enumeration Date:
07/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MCCLENAHAN
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF MANAGER OF LLC
Authorized Official Telephone Number:
952-447-2345

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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