Healthcare Provider Details

I. General information

NPI: 1699369728
Provider Name (Legal Business Name): OPEN ARMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 PARK HEIGHTS AVE
BALTIMORE MD
21215-6324
US

IV. Provider business mailing address

4430 PARK HEIGHTS AVE
BALTIMORE MD
21215-6324
US

V. Phone/Fax

Practice location:
  • Phone: 443-627-3593
  • Fax:
Mailing address:
  • Phone: 443-627-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GREGORY MARTIN DIGGS
Title or Position: CEO
Credential:
Phone: 443-627-3593