Healthcare Provider Details

I. General information

NPI: 1154855591
Provider Name (Legal Business Name): OPEN ARMS BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W CORNERVIEW ST
GONZALES LA
70737-2742
US

IV. Provider business mailing address

PO BOX 359
GONZALES LA
70707-0359
US

V. Phone/Fax

Practice location:
  • Phone: 225-647-4105
  • Fax: 866-234-8190
Mailing address:
  • Phone: 225-647-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2203783205
License Number StateLA

VIII. Authorized Official

Name: DEMARCUS D PATTERSON
Title or Position: OWNER
Credential:
Phone: 225-647-4105