Provider Demographics
NPI:1669763694
Name:OPEN ARMS YOUTH & FAMILY SERVICES OF GASTONIA, LLC
Entity type:Organization
Organization Name:OPEN ARMS YOUTH & FAMILY SERVICES OF GASTONIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:DEVONNE
Authorized Official - Last Name:SHANKL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-361-5395
Mailing Address - Street 1:615 S NEW HOPE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4808
Mailing Address - Country:US
Mailing Address - Phone:704-865-9795
Mailing Address - Fax:704-865-9785
Practice Address - Street 1:615 S NEW HOPE RD STE 101
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4808
Practice Address - Country:US
Practice Address - Phone:704-865-9795
Practice Address - Fax:704-865-9785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health