Provider Demographics
NPI:1558609503
Name:OPEN HANDS AND WARM HEART PCA
Entity Type:Organization
Organization Name:OPEN HANDS AND WARM HEART PCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAREGIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FADUMO
Authorized Official - Middle Name:ABDI
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-545-6723
Mailing Address - Street 1:3777 E MCDOWELL RD APT 1098
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4351
Mailing Address - Country:US
Mailing Address - Phone:612-545-6723
Mailing Address - Fax:602-687-7824
Practice Address - Street 1:3777 E MCDOWELL RD APT 1098
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4351
Practice Address - Country:US
Practice Address - Phone:612-545-6723
Practice Address - Fax:602-687-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization