Provider Demographics
NPI:1114084134
Name:OPENARMSGROUPHOMESINC
Entity Type:Organization
Organization Name:OPENARMSGROUPHOMESINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-777-8311
Mailing Address - Street 1:4606 CLOVERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-9462
Mailing Address - Country:US
Mailing Address - Phone:704-777-8311
Mailing Address - Fax:704-853-3703
Practice Address - Street 1:4606 CLOVERWOOD LN
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-9462
Practice Address - Country:US
Practice Address - Phone:704-777-8311
Practice Address - Fax:704-691-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418117Other(CAP)PROVIDER ID
NC8300686BMedicaid