NPIMap

Organization Active NPI

Open Door Center for Change LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Madison, WI
National Provider Identifier
1215068069
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
OPEN DOOR CENTER FOR CHANGE LLC
Practice address
6502 Grand Teton PLZ Ste 102
Madison, WI 53719-1047
Phone
(608) 827-7220
Fax
(608) 827-7223
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Ms. Amy J Mosher-Garvey, LCSW, CSACNPI 1831258060
Title
Co-Owner
Phone
(608) 827-7220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

6502 Grand Teton PLZ Ste 102
Madison, WI 53719-1047

Mailing address

6502 Grand Teton PLZ Ste 102
Madison, WI 53719-1047
Phone (608) 827-7220

Other practice location 1

2820 Walton Commons Ln Ste 128
Madison, WI 53718-6797
Phone (608) 827-7220

Other identifiers 1

IdentifierTypeStateIssuer
42198900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070509000503 WI Part B Supplier - Clinic/Group Practice 2860598711 Receives reassigned benefits from 18 practitioners
Practice locations: Madison, WI

National Provider Directory

National Provider Directory

Locations

6502 Grand Teton Plz
Ste 102
Madison, WI 53719
Phone (608) 827-7220

6502 Grand Teton Plz
Ste 206
Madison, WI 53719
Phone (608) 827-7220

3324 Milwaukee St
Ste C2
Madison, WI 53714
Phone (608) 827-7220

2820 Walton Commons Ln
Ste 128
Madison, WI 53718
Phone (608) 827-7220

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1215068069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6502 GRAND TETON PLZ STE 102",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191047",
            "telephone_number": "608-827-7220",
            "fax_number": "608-827-7223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6502 GRAND TETON PLZ STE 102",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191047",
            "telephone_number": "608-827-7220",
            "fax_number": "608-827-7223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2820 Walton Commons Ln Ste 128",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537186797",
            "country_code": "US",
            "telephone_number": "608-827-7220",
            "fax_number": "608-827-7223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPEN DOOR CENTER FOR CHANGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "MOSHER-GARVEY",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "608-827-7220",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW, CSAC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42198900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.