Open Door Group Home#, Incorporated

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL036249 Issued in NC

Legal business name

OPEN DOOR GROUP HOME#, INCORPORATED

Practice address

140 Shady Grove Rd
Kings Mountain, NC 28086-9669

Phone

(704) 739-6650

NPI assigned

Oct 31, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Betty Ann Gravely, MAEDU

Title

Owner/Director

Phone

(704) 739-6650

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1184803686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 SHADY GROVE RD",
            "city": "KINGS MOUNTAIN",
            "state": "NC",
            "postal_code": "280869669",
            "telephone_number": "704-739-6650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 SHADY GROVE RD",
            "city": "KINGS MOUNTAIN",
            "state": "NC",
            "postal_code": "280869669",
            "telephone_number": "704-739-6650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR GROUP HOME#, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-31",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "GRAVELY",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "704-739-6650",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MAEDU"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL036249",
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL036249",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL036249",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Kings Mountain, NC
• Providers in Kings Mountain, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.