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General NPI Number Information
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NPI Number | 1114446283
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Entity Type | Organization
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Legal Business Name | OPEN DOOR HEALTH CENTER
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 115 BROADWAY ST S
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City | JORDAN
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State | MN
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Zip | 55352-1664
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Country | US
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Telephone | 507-388-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 309 HOLLY LN
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City | MANKATO
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State | MN
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Zip | 56001-5422
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Country | US
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Telephone | 507-388-2120
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JENNIFER BECKIUS
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Credential |
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Telephone | 507-344-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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