Provider Demographics
NPI:1548696651
Name:KELLY'S HOUSE OF OPEN ARMS
Entity type:Organization
Organization Name:KELLY'S HOUSE OF OPEN ARMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER , LCDC
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-644-9975
Mailing Address - Street 1:4230 TREE MOSS PL
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4560
Mailing Address - Country:US
Mailing Address - Phone:832-644-9975
Mailing Address - Fax:
Practice Address - Street 1:4230 TREE MOSS PL
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4560
Practice Address - Country:US
Practice Address - Phone:832-644-9975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X, 324500000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility