Provider Demographics
NPI:1881837854
Name:OPEN ARMS
Entity Type:Organization
Organization Name:OPEN ARMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOREIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EPHRAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-813-3041
Mailing Address - Street 1:317 BAREFOOT RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8220
Mailing Address - Country:US
Mailing Address - Phone:910-848-0959
Mailing Address - Fax:910-848-0959
Practice Address - Street 1:172 DREW ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6639
Practice Address - Country:US
Practice Address - Phone:910-848-1116
Practice Address - Fax:910-848-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-047-116320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-047-116OtherMENTAL HEALTH LICENSURE NUMBER