Provider Demographics
NPI:1255576054
Name:OPEN DOOR ALCOHOLISM TREATMENT PROGRAM
Entity type:Organization
Organization Name:OPEN DOOR ALCOHOLISM TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CSW, CADC, CJC
Authorized Official - Phone:732-246-4800
Mailing Address - Street 1:2-4 NEW & KIRKPATRICK ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901
Mailing Address - Country:US
Mailing Address - Phone:732-246-4800
Mailing Address - Fax:732-246-4860
Practice Address - Street 1:2 KIRKPATRICK ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1902
Practice Address - Country:US
Practice Address - Phone:732-246-4800
Practice Address - Fax:732-246-4860
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW HOPE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ81351324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7632100Medicaid
NJ8631808Medicaid