Provider Demographics
NPI:1609323088
Name:INNER DOOR CENTER, LLC
Entity Type:Organization
Organization Name:INNER DOOR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF STRATEGY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-928-8863
Mailing Address - Street 1:317 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2735
Mailing Address - Country:US
Mailing Address - Phone:248-336-2868
Mailing Address - Fax:248-336-2879
Practice Address - Street 1:317 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2735
Practice Address - Country:US
Practice Address - Phone:248-336-2868
Practice Address - Fax:248-336-2879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNER DOOR HOLDINGS, LLC (DE)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health