Healthcare Provider Details

I. General information

NPI: 1184792376
Provider Name (Legal Business Name): OPEN DOOR REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S WELLS
SANDWICH IL
60648-2459
US

IV. Provider business mailing address

405 S WELLS
SANDWICH IL
60648-2459
US

V. Phone/Fax

Practice location:
  • Phone: 815-786-8468
  • Fax: 815-786-6241
Mailing address:
  • Phone: 815-786-8468
  • Fax: 815-786-6241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID CHARLES BAKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 815-786-8468