Provider Demographics
NPI:1508907338
Name:OPEN DOORS FOR THE DEVELOPMENTALLY CHALLENGED, INC.
Entity Type:Organization
Organization Name:OPEN DOORS FOR THE DEVELOPMENTALLY CHALLENGED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-645-2130
Mailing Address - Street 1:211 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1423
Mailing Address - Country:US
Mailing Address - Phone:304-645-2130
Mailing Address - Fax:304-647-9943
Practice Address - Street 1:211 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1423
Practice Address - Country:US
Practice Address - Phone:304-645-2130
Practice Address - Fax:304-647-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005236000Medicaid