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General NPI Number Information
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NPI Number | 1336413665
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Entity Type | Organization
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Legal Business Name | OPEN DOOR HOME HEALTH CARE & COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 1900 MARTIN LUTHER KING JR DR P
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City | WINSTON-SALEM
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State | NC
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Zip | 27107-1348
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Country | US
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Telephone | 336-734-6919
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 MLK JR DR
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City | WINSTON-SALEM
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State | NC
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Zip | 27107-1348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SIMONE WHITE
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Credential |
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Telephone | 336-734-6919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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