Healthcare Provider Details

I. General information

NPI: 1245003300
Provider Name (Legal Business Name): SHEPHERDS DOOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W MOUNTAIN ST STE 108D
PASADENA CA
91103-2968
US

IV. Provider business mailing address

PO BOX 40441
PASADENA CA
91114-7441
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-9968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA OFFRAY
Title or Position: CHIEF EXECUTIVE DIRECTOR
Credential:
Phone: 626-765-9968