Healthcare Provider Details

I. General information

NPI: 1700795622
Provider Name (Legal Business Name): OPEN ARMS YOUTH GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 CUSTER ST
PHILADELPHIA PA
19134-2409
US

IV. Provider business mailing address

3156 CUSTER ST
PHILADELPHIA PA
19134-2409
US

V. Phone/Fax

Practice location:
  • Phone: 267-670-4028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MIATTA BORKAI
Title or Position: DIRECTOR
Credential:
Phone: 267-670-4028