OPEN DOOR COMMUNITY HEALTH CENTERS

Provider Demographics

• NPI: 1881873958
• Name: OPEN DOOR COMMUNITY HEALTH CENTERS
• Entity type: Organization
• Organization Name: OPEN DOOR COMMUNITY HEALTH CENTERS
• Authorized Official - Title/Position: PRESIDENT/CEO
• Authorized Official - First Name: VICTOR
• Authorized Official - Last Name: STARR
• Authorized Official - Phone: 707-826-8633
• Mailing Address - Street 1: 1275 8TH ST
• Mailing Address - City: ARCATA
• Mailing Address - State: CA
• Mailing Address - Zip Code: 95521-5770
• Mailing Address - Country: US
• Mailing Address - Phone: 707-826-8633
• Mailing Address - Fax: 707-826-8638
• Practice Address - Street 1: 1275 8TH ST
• Practice Address - City: ARCATA
• Practice Address - State: CA
• Practice Address - Zip Code: 95521-5770
• Practice Address - Country: US
• Practice Address - Phone: 707-826-8633
• Practice Address - Fax: 707-826-8638
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-10-25
• Last Update Date: 2023-06-07

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QF0400X	Ambulatory Health Care Facilities	Clinic/Center	Federally Qualified Health Center (FQHC)
No	207VX0000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Obstetrics	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	FHC03892F	Medicaid
CA	FHC03920F	Medicaid
CA	ZZZ36797Z	Other	MEDICARE PART B
CA	55-1916	Other	MEDICARE PART A
CA	FHC71103F	Medicaid
CA	ZZZ21581Z	Other	MEDICARE PART B
CA	ZZZ27933Z	Other	MEDICARE PART B
CA	05-1055	Other	MEDICARE PART A
CA	05-1941	Other	MEDICARE PART A
CA	FHC70970F	Medicaid
CA	ZZZ75686Z	Other	MEDICARE PART B
CA	05-1940	Other	MEDICARE PART A
CA	55-1818	Other	MEDICARE PART A
CA	FHC03919F	Medicaid
CA	FHC70779F	Medicaid
CA	ZZZ29825Z	Other	MEDICARE PART B
CA	55-1917	Other	MEDICARE PART A
CA	FHC70869F	Medicaid
CA	05-1942	Other	MEDICARE PART A
CA	FHC03890G	Medicaid