MEDICARE: OPEN HAND 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1629729116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN HAND LLC

Provider Business Mailing Address
First Line	:	4801 S LAKESHORE DR STE 108
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 S LAKESHORE DR STE 108
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7156
Country	:	US
Telephone Number	:	775-813-9703
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BLADIMIK JARA
Credential	:
Telephone Number	:	775-813-9703

Provider Enumeration Date	:	01/16/2022
Last Update Date	:	01/16/2022

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Directions to “OPEN HAND LLC ” Practice Location

Language	Start Address	Practice Location

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