Provider Demographics
NPI:1801217021
Name:OPEN ARMS TCM
Entity Type:Organization
Organization Name:OPEN ARMS TCM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAREA
Authorized Official - Middle Name:SHAVONNE
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:352-742-8020
Mailing Address - Street 1:1609 BANNING BEACH RD
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2024
Mailing Address - Country:US
Mailing Address - Phone:352-742-8020
Mailing Address - Fax:352-742-8025
Practice Address - Street 1:1609 BANNING BEACH RD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2024
Practice Address - Country:US
Practice Address - Phone:352-742-8020
Practice Address - Fax:352-742-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008103600Medicaid