MEDICARE: OPEN DOOR INTERNATIONAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1568527000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN DOOR INTERNATIONAL

Provider Business Mailing Address
First Line	:	5812 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4812
Country	:	US
Telephone Number	:	407-381-3400
Fax Number	:	407-381-3402

Provider Business Practice Location Address
First Line	:	5766 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4818
Country	:	US
Telephone Number	:	407-896-2323
Fax Number	:	407-896-7760

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	PAUL LANGLEY
Credential	:
Telephone Number	:	407-896-2323

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	08/22/2020

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Directions to “OPEN DOOR INTERNATIONAL ” Practice Location

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