MEDICARE: OPEN ARMS PRP LLC

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	MH1616	MD

General Provider Information

NPI Number	:	1366828691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN ARMS PRP LLC

Provider Business Mailing Address
First Line	:	5801 OLD SILVER HILL RD
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2108
Country	:	US
Telephone Number	:	301-793-3396
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 OLD SILVER HILL RD
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2108
Country	:	US
Telephone Number	:	301-793-3396
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. KATHY YOVNNE ANTHONY
Credential	:
Telephone Number	:	301-793-3396

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	08/10/2015

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