Provider Demographics
NPI:1174902555
Name:OPEN DOOR CLINIC
Entity type:Organization
Organization Name:OPEN DOOR CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-707-7704
Mailing Address - Street 1:157 S LINCOLN AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4264
Mailing Address - Country:US
Mailing Address - Phone:630-264-1819
Mailing Address - Fax:630-229-0182
Practice Address - Street 1:157 S LINCOLN AVE
Practice Address - Street 2:SUITE K
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4264
Practice Address - Country:US
Practice Address - Phone:630-264-1819
Practice Address - Fax:630-229-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty