=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801217021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPEN ARMS TCM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2013
-----------------------------------------------------
Last Update Date | 12/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1609 BANNING BEACH RD
-----------------------------------------------------
City | TAVARES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32778-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-742-8020
-----------------------------------------------------
Fax | 352-742-8025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1609 BANNING BEACH RD
-----------------------------------------------------
City | TAVARES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32778-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-742-8020
-----------------------------------------------------
Fax | 352-742-8025
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. CAREA SHAVONNE GUNN
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 352-742-8020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------