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General NPI Number Information
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NPI Number | 1215742713
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Entity Type | Organization
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Legal Business Name | OPEN MINDED DEVELOPMENTAL SERVICES, INC
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 2803 SUNSET AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3644
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Country | US
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Telephone | 252-446-1411
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Fax | 252-446-3351
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Provider Business Mailing Address
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Address Line | 2803 SUNSET AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3644
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Country | US
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Telephone | 252-446-1411
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Fax | 252-446-3351
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Authorized Official
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Title or Position | CREDENTIALING SPECIALISTS
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Name | KIMBERLY DAVIS
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Credential |
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Telephone | 912-373-4385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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