Healthcare Provider Details

I. General information

NPI: 1033904859
Provider Name (Legal Business Name): WITH OPEN ARMS RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BROWN ST
PORTAGE IN
46368-4748
US

IV. Provider business mailing address

3333 BROWN ST
PORTAGE IN
46368-4748
US

V. Phone/Fax

Practice location:
  • Phone: 219-718-6534
  • Fax:
Mailing address:
  • Phone: 219-718-6534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KARDETRA REDMOND
Title or Position: OWNER
Credential:
Phone: 219-718-6534