Provider Demographics
NPI:1316393408
Name:CHARLES AND ROSE KELLEY OPEN ARMS
Entity Type:Organization
Organization Name:CHARLES AND ROSE KELLEY OPEN ARMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:RAHMAAN
Authorized Official - Middle Name:N'KOSI
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM
Authorized Official - Phone:989-714-2925
Mailing Address - Street 1:718 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6262
Mailing Address - Country:US
Mailing Address - Phone:989-714-2925
Mailing Address - Fax:
Practice Address - Street 1:718 SOMERSET RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6262
Practice Address - Country:US
Practice Address - Phone:989-714-2925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICI730338770322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children