Provider Demographics
NPI:1942807698
Name:OPEN DOOR CENTER
Entity Type:Organization
Organization Name:OPEN DOOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SVENNINGSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-845-1124
Mailing Address - Street 1:129 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-3057
Mailing Address - Country:US
Mailing Address - Phone:701-845-1124
Mailing Address - Fax:
Practice Address - Street 1:129 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3057
Practice Address - Country:US
Practice Address - Phone:701-845-1124
Practice Address - Fax:701-845-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455738Medicaid