Provider Demographics
NPI:1619111085
Name:AN OPEN MIND, INC.
Entity Type:Organization
Organization Name:AN OPEN MIND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-495-8490
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1416
Mailing Address - Country:US
Mailing Address - Phone:954-495-8490
Mailing Address - Fax:954-495-8592
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-495-8490
Practice Address - Fax:954-495-8592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3182002163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCT279AMedicare UPIN