Provider Demographics
NPI:1417755984
Name:YELLOW DOORS 2119
Entity type:Organization
Organization Name:YELLOW DOORS 2119
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-320-2556
Mailing Address - Street 1:3904 NOYES CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2746
Mailing Address - Country:US
Mailing Address - Phone:202-320-2556
Mailing Address - Fax:
Practice Address - Street 1:1842 PROVIDENCE ST NE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1770
Practice Address - Country:US
Practice Address - Phone:202-320-2556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp