MEDICARE: OPEN ARMS BEHAVIOR AND HEALTH 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

General Provider Information

NPI Number	:	1720646730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN ARMS BEHAVIOR AND HEALTH LLC.

Provider Business Mailing Address
First Line	:	3040 SIMMONS ST STE 103
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3805
Country	:	US
Telephone Number	:	702-569-4582
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 SIMMONS ST STE 103
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3805
Country	:	US
Telephone Number	:	702-569-4582
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TROY L POLLOCK
Credential	:
Telephone Number	:	702-569-4582

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	06/04/2019

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