Healthcare Provider Details

I. General information

NPI: 1083914717
Provider Name (Legal Business Name): OPEN ARMS CHRISTIAN MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 W STATE ROAD 54
BLOOMFIELD IN
47424-5207
US

IV. Provider business mailing address

4516 W STATE ROAD 54
BLOOMFIELD IN
47424-5207
US

V. Phone/Fax

Practice location:
  • Phone: 812-659-2533
  • Fax: 812-659-2477
Mailing address:
  • Phone: 812-659-2533
  • Fax: 812-659-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number155516933 43620
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. MARTIN COREY
Title or Position: EXECUTIVE DIRECTOR
Credential: MAMFT
Phone: 812-659-2533