Healthcare Provider Details

I. General information

NPI: 1073765251
Provider Name (Legal Business Name): DOOR OF OPPORTUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S 14TH ST
ARTESIA NM
88210-1795
US

IV. Provider business mailing address

PO BOX 208
ARTESIA NM
88211-0208
US

V. Phone/Fax

Practice location:
  • Phone: 575-736-2040
  • Fax:
Mailing address:
  • Phone: 575-736-2040
  • 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: MS. SHANNON M WADDELL
Title or Position: BILLING SPECIALIST
Credential:
Phone: 575-736-2040