Healthcare Provider Details

I. General information

NPI: 1750832564
Provider Name (Legal Business Name): FIRST DOOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25584 W 10 MILE RD
SOUTHFIELD MI
48033-4826
US

IV. Provider business mailing address

25584 W 10 MILE RD
SOUTHFIELD MI
48033-4826
US

V. Phone/Fax

Practice location:
  • Phone: 248-877-8401
  • Fax: 313-454-3102
Mailing address:
  • Phone: 248-877-8401
  • Fax: 313-454-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberAS630369663
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAS630369663
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberAS630369663
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberAS630369663
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberAS630369663
License Number StateMI

VIII. Authorized Official

Name: MR. MODEIRA JOHNSON SR.
Title or Position: OWNER/CEO/PRESIDENT
Credential:
Phone: 248-877-8401