Healthcare Provider Details

I. General information

NPI: 1114476413
Provider Name (Legal Business Name): WITH OPEN ARMS / REPRODUCTIVE HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 LUCAS ST STE B
EUREKA CA
95501-3340
US

IV. Provider business mailing address

2505 LUCAS ST STE B
EUREKA CA
95501-3340
US

V. Phone/Fax

Practice location:
  • Phone: 707-442-0400
  • Fax: 707-442-0404
Mailing address:
  • Phone: 707-442-0400
  • Fax: 707-442-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW 235678
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG44510
License Number StateCA

VIII. Authorized Official

Name: DR. TIMOTHY PAIK-NICELY
Title or Position: OWNER
Credential: M.D.
Phone: 707-442-0400