Healthcare Provider Details

I. General information

NPI: 1104680958
Provider Name (Legal Business Name): OPEN MINDED HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOLIDAY DR STE C-1
SOLOMONS MD
20688
US

IV. Provider business mailing address

PO BOX 1305
SOLOMONS MD
20688-1305
US

V. Phone/Fax

Practice location:
  • Phone: 667-910-8540
  • Fax: 667-200-4711
Mailing address:
  • Phone: 667-910-8540
  • Fax: 667-200-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. OSAZE ERNEST OKORO
Title or Position: MEDICAL DIRECTOR/CEO
Credential: DNP
Phone: 443-557-8719