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General NPI Number Information
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NPI Number | 1669569109
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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 | 10/06/2006
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 2200 TYDD ST
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City | EUREKA
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State | CA
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Zip | 95501-1284
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Country | US
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Telephone | 707-441-1624
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Fax | 707-441-1253
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Provider Business Mailing Address
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Address Line | 670 NINTH STREET SUITE 203
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City | ARCATA
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State | CA
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Zip | 95521
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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 | COO
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Name | CHEYENNE SPETZLER
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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 | 010000223
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 110000223
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License Number State | CA
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