Provider Demographics
NPI:1275532293
Name:OPEN ARMS HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:OPEN ARMS HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGALAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-282-6272
Mailing Address - Street 1:4001 W DEVON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4523
Mailing Address - Country:US
Mailing Address - Phone:773-282-6272
Mailing Address - Fax:773-282-6273
Practice Address - Street 1:4001 W DEVON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4523
Practice Address - Country:US
Practice Address - Phone:773-282-6272
Practice Address - Fax:773-282-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010304251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid