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General NPI Number Information
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NPI Number | 1952304339
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Entity Type | Organization
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Legal Business Name | OPEN MINDED DEVELOPMENTAL HOME CARE INC
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 2803 SUNSET AVENUE
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City | ROCKY MOUNT
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State | NC
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Zip | 27804
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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 AVENUE
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City | ROCKY MOUNT
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State | NC
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Zip | 27804
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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 | DIRECTOR
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Name | SANDRA RANA BRYANT-RICHARDSON
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Credential |
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Telephone | 252-446-1411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC1999
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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