Healthcare Provider Details

I. General information

NPI: 1689778813
Provider Name (Legal Business Name): OPEN DOOR COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 18TH STREET
ARCATA CA
95521
US

IV. Provider business mailing address

1275 8TH ST
ARCATA CA
95521-5770
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-2481
  • Fax: 707-822-3656
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: VICTOR A STARR
Title or Position: PRESIDENT/ CEO
Credential:
Phone: 707-826-8633