Provider Demographics
NPI:1457793788
Name:OPEN DOOR EQUINE INC
Entity Type:Organization
Organization Name:OPEN DOOR EQUINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-416-8632
Mailing Address - Street 1:5692 N JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:MC CORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9694
Mailing Address - Country:US
Mailing Address - Phone:317-416-8632
Mailing Address - Fax:
Practice Address - Street 1:5129 N 600 W
Practice Address - Street 2:
Practice Address - City:MC CORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-9511
Practice Address - Country:US
Practice Address - Phone:317-416-8632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health