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General NPI Number Information
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NPI Number | 1073765251
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Entity Type | Organization
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Legal Business Name | DOOR OF OPPORTUNITY
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 108 S 14TH ST
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City | ARTESIA
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State | NM
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Zip | 88210-1795
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Country | US
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Telephone | 575-736-2040
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 208
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City | ARTESIA
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State | NM
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Zip | 88211-0208
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Country | US
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Telephone | 575-736-2040
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Fax |
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | MS. SHANNON M WADDELL
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Credential |
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Telephone | 575-736-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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