Provider Demographics
NPI:1487293940
Name:OPEN DOOR OUTREACH CENTER
Entity type:Organization
Organization Name:OPEN DOOR OUTREACH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-350-2863
Mailing Address - Street 1:13604 OLD ANNAPOLIS ROAD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720
Mailing Address - Country:US
Mailing Address - Phone:202-417-4880
Mailing Address - Fax:
Practice Address - Street 1:13604 OLD ANNAPOLIS ROAD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720
Practice Address - Country:US
Practice Address - Phone:202-417-4880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No174200000XOther Service ProvidersMeals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Yes251B00000XAgenciesCase Management