Provider Demographics
NPI:1740990837
Name:DOORS OPEN HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:DOORS OPEN HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:510-385-6866
Mailing Address - Street 1:5040 N 15TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3329
Mailing Address - Country:US
Mailing Address - Phone:510-385-6866
Mailing Address - Fax:
Practice Address - Street 1:5040 N 15TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3329
Practice Address - Country:US
Practice Address - Phone:510-385-6866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center