Healthcare Provider Details

I. General information

NPI: 1497840656
Provider Name (Legal Business Name): OPEN DOOR COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WASHINGTON BLVD
CRESCENT CITY CA
95531-8342
US

IV. Provider business mailing address

1275 8TH ST
ARCATA CA
95521-5770
US

V. Phone/Fax

Practice location:
  • Phone: 707-465-6925
  • Fax: 707-465-6070
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number010000215
License Number StateCA

VIII. Authorized Official

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