Healthcare Provider Details

I. General information

NPI: 1588255459
Provider Name (Legal Business Name): OPEN DOOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 117TH AVE SE
VALLEY CITY ND
58072
US

IV. Provider business mailing address

129 3RD AVE NE
VALLEY CITY ND
58072-3057
US

V. Phone/Fax

Practice location:
  • Phone: 701-845-5114
  • Fax: 701-845-1175
Mailing address:
  • Phone: 701-845-1124
  • Fax: 701-845-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MARCY R SVENNINGSEN
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 701-845-1124