Healthcare Provider Details

I. General information

NPI: 1144917006
Provider Name (Legal Business Name): OPEN ARMS YOUTH HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10904 E SEBRING AVE
MESA AZ
85212-5229
US

IV. Provider business mailing address

1525 S HIGLEY RD. STE 104 PMB 1205
GILBERT AZ
85296-5045
US

V. Phone/Fax

Practice location:
  • Phone: 480-984-1795
  • Fax: 480-984-1795
Mailing address:
  • Phone: 480-984-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ELVIS WAYNE DICKSON
Title or Position: FOUNDER/CEO
Credential:
Phone: 480-984-1795