Provider Demographics
NPI:1952173817
Name:OPEN DOORS THERAPEUTIC HOME LLC
Entity Type:Organization
Organization Name:OPEN DOORS THERAPEUTIC HOME LLC
Other - Org Name:HEART OF GOLDSENIOR HOMECARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:CHIDINMA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:SALAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-749-8176
Mailing Address - Street 1:38212 W SANTA BARBARA AVE
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5302
Mailing Address - Country:US
Mailing Address - Phone:602-364-9925
Mailing Address - Fax:
Practice Address - Street 1:38212 W SANTA BARBARA AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5302
Practice Address - Country:US
Practice Address - Phone:602-364-9925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty