Healthcare Provider Details

I. General information

NPI: 1659889574
Provider Name (Legal Business Name): OPEN ARMS HOME ASSISTANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 S HARPER AVE STE 2C
CHICAGO IL
60615-4119
US

IV. Provider business mailing address

6730 ONTARIO AVE
HAMMOND IN
46323-1440
US

V. Phone/Fax

Practice location:
  • Phone: 219-741-1470
  • Fax:
Mailing address:
  • Phone: 219-741-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH WESTON
Title or Position: OWNER/COO
Credential:
Phone: 219-741-1470