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General NPI Number Information
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NPI Number | 1336173020
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Entity Type | Organization
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Legal Business Name | OPEN DOOR COMMUNITY HEALTH CENTERS
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 2426 BUHNE ST
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City | EUREKA
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State | CA
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Zip | 95501-3207
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Country | US
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Telephone | 707-442-4038
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Fax | 707-442-4039
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Provider Business Mailing Address
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Address Line | 1275 8TH ST
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City | ARCATA
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State | CA
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Zip | 95521-5770
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Country | US
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Telephone | 707-826-8633
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Fax | 707-826-8638
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | VICTOR STARR
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Credential |
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Telephone | 707-826-8633
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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 | 550000105
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License Number State | CA
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