MEDICARE: OPEN ARMS VISITATION CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1053625186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN ARMS VISITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	3630 N RANCHO DR STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3111
Country	:	US
Telephone Number	:	702-570-6300
Fax Number	:	702-570-6302

Provider Business Practice Location Address
First Line	:	3630 N RANCHO DR STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3111
Country	:	US
Telephone Number	:	702-570-6300
Fax Number	:	702-570-6302

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. DIANA W DILLON
Credential	:
Telephone Number	:	702-570-6300

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/30/2010

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