Healthcare Provider Details

I. General information

NPI: 1124887484
Provider Name (Legal Business Name): OPEN ARMS RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 GRIFFIN AVE
SOMERSET KY
42501-2259
US

IV. Provider business mailing address

166 GRIFFIN AVE
SOMERSET KY
42501-2259
US

V. Phone/Fax

Practice location:
  • Phone: 859-494-2656
  • Fax:
Mailing address:
  • Phone: 859-494-2656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BONITA LESHA CLAIBORNE
Title or Position: CEO
Credential:
Phone: 859-494-2656