Provider Demographics
NPI:1043939655
Name:OPEN HEARTS OPEN ARMS
Entity Type:Organization
Organization Name:OPEN HEARTS OPEN ARMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-324-6101
Mailing Address - Street 1:200 E BROADWAY AVE STE B-31
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5709
Mailing Address - Country:US
Mailing Address - Phone:865-324-6100
Mailing Address - Fax:865-238-0313
Practice Address - Street 1:200 E BROADWAY AVE STE B-31
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5709
Practice Address - Country:US
Practice Address - Phone:865-324-6100
Practice Address - Fax:865-238-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ053587Medicaid