Provider Demographics
NPI:1760998934
Name:OPEN HEARTS & OPEN DOORS GROUP HOME SERVICES, LLC
Entity Type:Organization
Organization Name:OPEN HEARTS & OPEN DOORS GROUP HOME SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLET
Authorized Official - Middle Name:F
Authorized Official - Last Name:ORIAKHI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:512-400-5137
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-0532
Mailing Address - Country:US
Mailing Address - Phone:512-400-5137
Mailing Address - Fax:512-494-6110
Practice Address - Street 1:11605 MILL RIDGE TRCE
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653
Practice Address - Country:US
Practice Address - Phone:512-400-5137
Practice Address - Fax:512-494-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities