Basic Information
| Provider Information | |||||||||
| NPI: | 1174250492 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPEN DOOR COMMUNITY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1275 8TH ST | ||||||||
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| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955215770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078268633 | ||||||||
| FaxNumber: | 7078268638 | ||||||||
| Practice Location | |||||||||
| Address1: | 1915 J ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955013052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074434666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2022 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | STARR | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7078268633 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.