MEDICARE: OPEN ARMS GROUP HOME INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003097338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN ARMS GROUP HOME INC.

Provider Business Mailing Address
First Line	:	4474 LINDSEY DR
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-3467
Country	:	US
Telephone Number	:	770-944-8828
Fax Number	:	770-944-0128

Provider Business Practice Location Address
First Line	:	5752 AUSTELL POWDER SPRINGS RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-3231
Country	:	US
Telephone Number	:	770-944-8828
Fax Number	:	770-944-0128

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TERRI LOUISE BARNES
Credential	:	MSW
Telephone Number	:	770-944-8828

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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