Provider Demographics
NPI:1750832564
Name:FIRST DOOR, LLC
Entity Type:Organization
Organization Name:FIRST DOOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MODEIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:248-877-8401
Mailing Address - Street 1:25584 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4826
Mailing Address - Country:US
Mailing Address - Phone:248-877-8401
Mailing Address - Fax:313-454-3102
Practice Address - Street 1:25584 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4826
Practice Address - Country:US
Practice Address - Phone:248-877-8401
Practice Address - Fax:313-454-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X, 261QR0401X, 314000000X
MIAS630369663311Z00000X, 311ZA0620X, 320700000X, 320800000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385H00000XRespite Care FacilityRespite Care