Healthcare Provider Details

I. General information

NPI: 1801198544
Provider Name (Legal Business Name): OPEN DOOR INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 GREEN ST
CLAYMONT DE
19703-2052
US

IV. Provider business mailing address

3301 GREEN ST
CLAYMONT DE
19703-2052
US

V. Phone/Fax

Practice location:
  • Phone: 302-798-9555
  • Fax: 302-198-9550
Mailing address:
  • Phone: 302-798-9555
  • Fax: 302-798-9550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WIILIAM DIFABIO
Title or Position: COO
Credential:
Phone: 610-636-1488