Healthcare Provider Details

I. General information

NPI: 1164261863
Provider Name (Legal Business Name): OPEN ARMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 IVY LN STE 330
GREENBELT MD
20770-6349
US

IV. Provider business mailing address

5804 ANNAPOLIS RD APT 907
BLADENSBURG MD
20710-2016
US

V. Phone/Fax

Practice location:
  • Phone: 443-415-4149
  • Fax:
Mailing address:
  • Phone: 443-415-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. VALENTINE AMAH BAMA
Title or Position: FOUNDER
Credential:
Phone: 443-415-4149