Provider Demographics
NPI:1689924565
Name:OPEN DOOR FAMILY CENTER, LLC
Entity Type:Organization
Organization Name:OPEN DOOR FAMILY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMADOU
Authorized Official - Middle Name:
Authorized Official - Last Name:NDIAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-218-8570
Mailing Address - Street 1:16320 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2440
Mailing Address - Country:US
Mailing Address - Phone:586-218-8570
Mailing Address - Fax:586-944-2731
Practice Address - Street 1:16320 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2440
Practice Address - Country:US
Practice Address - Phone:586-218-8570
Practice Address - Fax:586-944-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS630312762305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization