Provider Demographics
NPI:1346695475
Name:OPEN ARMS TREATMENT
Entity Type:Organization
Organization Name:OPEN ARMS TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-484-8444
Mailing Address - Street 1:2331 N STATE ROAD 7
Mailing Address - Street 2:101
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3748
Mailing Address - Country:US
Mailing Address - Phone:954-484-8444
Mailing Address - Fax:
Practice Address - Street 1:2331 N STATE ROAD 7
Practice Address - Street 2:101
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3748
Practice Address - Country:US
Practice Address - Phone:954-484-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIX FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-26
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2517192261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304370300Medicaid