Provider Demographics
NPI:1790473221
Name:OPEN ARMS ELDERCARE LLC
Entity Type:Organization
Organization Name:OPEN ARMS ELDERCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANAE
Authorized Official - Middle Name:DOMINIQUE
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-946-3598
Mailing Address - Street 1:21 AUGUSTA CT APT 201
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-4622
Mailing Address - Country:US
Mailing Address - Phone:832-946-3598
Mailing Address - Fax:
Practice Address - Street 1:21 AUGUSTA CT APT 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-4622
Practice Address - Country:US
Practice Address - Phone:832-946-3598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health