MEDICARE: OPEN DOOR CENTER

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	251S00000X	Community/Behavioral Health Agency

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

General Provider Information

NPI Number	:	1942807698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN DOOR CENTER

Provider Business Mailing Address
First Line	:	129 3RD AVE NE
Second Line	:
City	:	VALLEY CITY
State	:	ND
Zip	:	58072-3057
Country	:	US
Telephone Number	:	701-845-1124
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 3RD AVE NE
Second Line	:
City	:	VALLEY CITY
State	:	ND
Zip	:	58072-3057
Country	:	US
Telephone Number	:	701-845-1124
Fax Number	:	701-845-1175

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	MARCY R SVENNINGSEN
Credential	:
Telephone Number	:	701-845-1124

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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Directions to “OPEN DOOR CENTER ” Practice Location

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