MEDICARE: OPEN MINDED DEVELOPMENTAL HOME CARE INC

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	251E00000X	Home Health Agency	HC1999	NC
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699945089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MINDED DEVELOPMENTAL HOME CARE INC

Provider Business Mailing Address
First Line	:	PO BOX 4427
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803-0427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2803 SUNSET AVE
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-3644
Country	:	US
Telephone Number	:	252-446-1411
Fax Number	:	252-446-3351

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SANDRA RANA BRYANT-RICHARDSON
Credential	:
Telephone Number	:	252-446-1411

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	12/19/2023

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