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1881873958

NPI Code Detail

MEDICARE: OPEN DOOR COMMUNITY HEALTH CENTERS

MEDICARE: OPEN DOOR COMMUNITY HEALTH CENTERS

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	207VX0000X	Obstetrics Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	ZZZ36797Z	OTHER	CA	MEDICARE PART B
4	55-1916	OTHER	CA	MEDICARE PART A
6	ZZZ21581Z	OTHER	CA	MEDICARE PART B
7	ZZZ27933Z	OTHER	CA	MEDICARE PART B
8	05-1055	OTHER	CA	MEDICARE PART A
9	05-1941	OTHER	CA	MEDICARE PART A
11	ZZZ75686Z	OTHER	CA	MEDICARE PART B
12	05-1940	OTHER	CA	MEDICARE PART A
13	55-1818	OTHER	CA	MEDICARE PART A
16	ZZZ29825Z	OTHER	CA	MEDICARE PART B
17	55-1917	OTHER	CA	MEDICARE PART A
19	05-1942	OTHER	CA	MEDICARE PART A

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881873958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN DOOR COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	1275 8TH ST
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-5770
Country	:	US
Telephone Number	:	707-826-8633
Fax Number	:	707-826-8638

Provider Business Practice Location Address
First Line	:	1275 8TH ST
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-5770
Country	:	US
Telephone Number	:	707-826-8633
Fax Number	:	707-826-8638

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	VICTOR STARR
Credential	:
Telephone Number	:	707-826-8633

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	06/07/2023

Similar Medicare Providers

1073478798 — TEXAS JOSHUA MCCUE-GREEN RN
Practice Location Address:

1275 8TH ST
ARCATA, CA
95521-5770

Practice Phone: 707-826-8633
Practice Fax: 707-826-6838

1891225611 — DR. JOELLE POTTS DO
Practice Location Address:

1275 8TH ST
ARCATA, CA
95521-5770

Practice Phone: 707-822-2481
Practice Fax: 707-822-3656

1114689924 — ROSEMARY CORCORAN RN
Practice Location Address:

1275 8TH ST
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95521-5770

Practice Phone: 707-826-8633
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1497455950 — RYO SEQUEIRA RN
Practice Location Address:

1275 8TH ST
ARCATA, CA
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Practice Phone: 707-826-8633
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1861192320 — MICHAEL GARCIA RN
Practice Location Address:

1275 8TH ST
ARCATA, CA
95521-5770

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Practice Fax: 707-826-8638

1770348435 — MEGEN ALICE CASKEY RN
Practice Location Address:

1275 8TH ST
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Practice Phone: 707-826-8633
Practice Fax:

Directions to “OPEN DOOR COMMUNITY HEALTH CENTERS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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