Provider Demographics
NPI:1417215112
Name:AN OPEN DOOR
Entity Type:Organization
Organization Name:AN OPEN DOOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:575-382-2107
Mailing Address - Street 1:5818 NUNATAK PL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7929
Mailing Address - Country:US
Mailing Address - Phone:575-382-2170
Mailing Address - Fax:575-373-0121
Practice Address - Street 1:5818 NUNATAK PL
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7929
Practice Address - Country:US
Practice Address - Phone:575-382-2170
Practice Address - Fax:575-373-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health