Provider Demographics
NPI:1912080060
Name:OPEN DOOR HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:OPEN DOOR HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-281-4257
Mailing Address - Street 1:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-1676
Mailing Address - Country:US
Mailing Address - Phone:765-281-4257
Mailing Address - Fax:765-213-2769
Practice Address - Street 1:905 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-2333
Practice Address - Country:US
Practice Address - Phone:765-286-7000
Practice Address - Fax:765-213-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200167970DMedicaid