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NPI Code Detail

MEDICARE: OPEN MINDED DEVELOPMENTAL HOME CARE INC

MEDICARE: OPEN MINDED DEVELOPMENTAL HOME CARE 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1649048463
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPEN MINDED DEVELOPMENTAL HOME CARE INC
Provider Business Mailing Address
First Line : 2803 SUNSET AVE
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-3644
Country : US
Telephone Number : 252-450-9086
Fax Number :
Provider Business Practice Location Address
First Line : 2803 SUNSET AVE
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-3644
Country : US
Telephone Number : 252-446-1411
Fax Number : 252-446-3351
Authorized Official
Title or Position : DIRECTOR
Name : SANDRA BRYANT
Credential :
Telephone Number : 252-450-9086
Provider Enumeration Date : 12/12/2023
Last Update Date : 12/12/2023

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Directions to “OPEN MINDED DEVELOPMENTAL HOME CARE INC ” Practice Location

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