Healthcare Provider Details

I. General information

NPI: 1770417404
Provider Name (Legal Business Name): OPEN DOOR HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FULTON ST # 204
MANKATO MN
56001-2520
US

IV. Provider business mailing address

309 HOLLY LN
MANKATO MN
56001-5422
US

V. Phone/Fax

Practice location:
  • Phone: 507-388-2120
  • Fax:
Mailing address:
  • Phone: 507-388-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BECKIUS
Title or Position: CFO/CO-CEO
Credential:
Phone: 507-344-5507