Provider Demographics
NPI:1336471804
Name:THE OPEN DOOR
Entity Type:Organization
Organization Name:THE OPEN DOOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-408-5681
Mailing Address - Street 1:1658 LAKEWOOD RD STE 12
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1280
Mailing Address - Country:US
Mailing Address - Phone:732-408-5681
Mailing Address - Fax:732-408-5683
Practice Address - Street 1:1658 LAKEWOOD RD STE 1-9
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1280
Practice Address - Country:US
Practice Address - Phone:732-408-5681
Practice Address - Fax:732-408-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400197950251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services