Provider Demographics
NPI:1023671740
Name:OPEN DOOR HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:OPEN DOOR HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-747-2971
Mailing Address - Street 1:333 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-2465
Mailing Address - Country:US
Mailing Address - Phone:765-286-7000
Mailing Address - Fax:765-213-2769
Practice Address - Street 1:1804-1806 WEST ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2243
Practice Address - Country:US
Practice Address - Phone:765-286-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)