Provider Demographics
NPI:1104504158
Name:OPEN ARMS INDEPENDENT LIVING FACILITY LLC
Entity type:Organization
Organization Name:OPEN ARMS INDEPENDENT LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-451-0245
Mailing Address - Street 1:2434 HEALY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3108
Mailing Address - Country:US
Mailing Address - Phone:407-420-8716
Mailing Address - Fax:407-286-5470
Practice Address - Street 1:2434 HEALY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3108
Practice Address - Country:US
Practice Address - Phone:407-420-8716
Practice Address - Fax:407-286-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities