Provider Demographics
NPI:1215693338
Name:OPEN DOOR COMMUNITY HEALTH CENTERS
Entity type:Organization
Organization Name:OPEN DOOR COMMUNITY HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-826-8633
Mailing Address - Street 1:1275 8TH ST
Mailing Address - Street 2:
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 1:26 SAMOA COAST LN
Practice Address - Street 2:
Practice Address - City:SAMOA
Practice Address - State:CA
Practice Address - Zip Code:95564-9535
Practice Address - Country:US
Practice Address - Phone:707-443-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPEN DOOR COMMUNITY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)