Healthcare Provider Details

I. General information

NPI: 1720632052
Provider Name (Legal Business Name): THE OPEN DOOR OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CHAMBERS BRIDGE RD APT 240
BRICK NJ
08723-3505
US

IV. Provider business mailing address

1658 LAKEWOOD RD STE 12
TOMS RIVER NJ
08755-1280
US

V. Phone/Fax

Practice location:
  • Phone: 732-408-5681
  • Fax:
Mailing address:
  • Phone: 732-408-5681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: NICOLE HALL
Title or Position: DIRECTOR OF SERVICES
Credential:
Phone: 732-408-5681