Provider Demographics
NPI:1457908303
Name:ARMS WIDE OPEN
Entity Type:Organization
Organization Name:ARMS WIDE OPEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-413-2241
Mailing Address - Street 1:871 FOREST PATH
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2245
Mailing Address - Country:US
Mailing Address - Phone:770-413-2241
Mailing Address - Fax:770-498-2778
Practice Address - Street 1:871 FOREST PATH
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2245
Practice Address - Country:US
Practice Address - Phone:770-413-2241
Practice Address - Fax:770-498-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health