Provider Demographics
NPI:1942841531
Name:THE OPEN DOOR
Entity Type:Organization
Organization Name:THE OPEN DOOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-283-6776
Mailing Address - Street 1:28 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2583
Mailing Address - Country:US
Mailing Address - Phone:978-283-6776
Mailing Address - Fax:
Practice Address - Street 1:28 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2583
Practice Address - Country:US
Practice Address - Phone:978-283-6776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty