1881837854 NPI number — OPEN ARMS

Table of content: (NPI 1881837854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881837854 NPI number — OPEN ARMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN ARMS
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:
1881837854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 BAREFOOT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28306-8220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-848-0959
Provider Business Mailing Address Fax Number:
910-848-0959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 DREW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAEFORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28376-6639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-848-1116
Provider Business Practice Location Address Fax Number:
910-848-1116
Provider Enumeration Date:
04/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
EPHRAIM
Authorized Official First Name:
TOREIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
910-813-3041

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  MHL-047-116 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MHL-047-116 . This is a "MENTAL HEALTH LICENSURE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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