Healthcare Provider Details

I. General information

NPI: 1578473013
Provider Name (Legal Business Name): OPEN DOORS HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 N BROADWAY
BALTIMORE MD
21213-3005
US

IV. Provider business mailing address

1525 N BROADWAY
BALTIMORE MD
21213-3005
US

V. Phone/Fax

Practice location:
  • Phone: 443-315-7793
  • Fax:
Mailing address:
  • Phone: 443-315-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: NJAMI NGUBUH NDANGUM
Title or Position: ADMINISTRATOR
Credential:
Phone: 443-683-9842