Organization Name: | OPEN DOOR GROUP HOME#, INCORPORATED |
NPI Number: | 1184803686 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BETTY ANN GRAVELY (OWNER/DIRECTOR) |
Mailing Address: | 140 Shady Grove Rd Kings Mountain |
State: | NC US |
Postal Code: | 280869669 |
Phone Number: | 7047396650 |
Fax Number: | |
NPI Enumeration Date: | 10/31/2007 |
NPI Last Update Date: | 10/31/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | MHL036249 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |