MEDICARE: OPEN ARMS MINNESOTA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1750513743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN ARMS MINNESOTA

Provider Business Mailing Address
First Line	:	550 VANDALIA ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1833
Country	:	US
Telephone Number	:	323-855-5656
Fax Number	:	310-876-0533

Provider Business Practice Location Address
First Line	:	550 VANDALIA ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1833
Country	:	US
Telephone Number	:	323-855-5656
Fax Number	:	310-876-0533

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. DAVID ELLIS
Credential	:
Telephone Number	:	323-855-5656

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	08/10/2009

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Directions to “OPEN ARMS MINNESOTA ” Practice Location

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