Open Door Community Health Centers
Organization Active NPI Federally Qualified Health Center (FQHC) · Crescent City, CA
NPI 1497840656 · NPPES record last updated Jun 7, 2023
Key facts
- NPI
- 1497840656
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 010000215 (CA)
- Legal business name
- OPEN DOOR COMMUNITY HEALTH CENTERS
- Practice address
- 550 E Washington Blvd
Crescent City, CA 95531-8342 - Phone
- (707) 465-6925
- Fax
- (707) 465-6070
- NPI assigned
- Oct 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Victor Starr
- Title
- President/Ceo
- Phone
- (707) 826-8633
Other NPIs on the same Medicare enrollment 12
Other NPIs with the same Medicare PAC ID 10
Practitioners 230
-
Amy Alfano, CNM, WHNP-BC
-
Theresa Anderson, N.P.
-
Carolina Arenas, LCSW
-
Sarah Darlene Beach, FNP
-
Angela Jean Beyer, APRN-BC
-
Jonathan H Bloch, D.O.
-
Carrie R. K. Brothers, PA-C
-
Gary Butler II, CRNP
-
Bruce S Campbell, LMFT
-
Danielle Leighann Cole, NP-C
-
Emily Davis, MD
-
Shaun Rebecca Edwards, APRN
-
Linda Ann Gardner, APRN
-
Cecilia Guerre, MD
-
Noelle Evonne Gunn, NP-C, PA-C
-
Emma Hackett, M.D.
-
Kendra Kay Hackney, FNP
-
Malia Ann Kiyomi Honda, M.D., M.S.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0676102 | Del Norte Community Health Center | Provider-performed microscopy | Aug 27, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 051941
- Legal name
- OPEN DOOR COMMUNITY HEALTH CENTERS
- Doing business as
- DEL NORTE COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 1, 1995
- Last certification
- Jan 1, 1995
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 18, 1971 in CA
- Enrollment address
- 550 E Washington Blvd
Ste 100
Crescent City, CA 95531-8161
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Victor a Starr |
Corporate Officer |
Jan 7, 2020 | |
| W-2 Managing Employee |
Jan 7, 2020 | ||
| Jay Molofsky |
Corporate Director |
Aug 26, 2019 | |
| John Driscoll |
Corporate Director |
Jul 26, 2021 | |
| Lindsay Righter |
Corporate Director |
Jan 1, 2012 | |
| Sarah Kerr |
Corporate Officer |
Jun 5, 2015 | |
| W-2 Managing Employee |
Jun 5, 2015 | ||
| Felicia Oldfather |
Corporate Director |
Jan 1, 2012 | |
| Kathleen Moxon |
Corporate Director |
Jul 1, 1999 | |
| Neal Sanders |
Corporate Director |
Jan 1, 1998 | |
| Stacy Watkins |
Corporate Officer |
May 30, 2007 | |
| W-2 Managing Employee |
Dec 17, 2001 | ||
| Sydney Fisher Larson |
Corporate Director |
Jul 1, 1999 | |
| Connie E Stewart |
Corporate Director |
Mar 1, 2009 | |
| Alison Talbot |
Corporate Director |
Sep 22, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040105000174 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 9436067485 | Practice locations: Crescent City, CA |
| O20040414000890 | CA | Part B Supplier - Clinic/Group Practice | 9436067485 |
Receives reassigned benefits from 211 practitioners 12 other NPIs on this enrollment Practice locations: Arcata, CA; Willow Creek, CA; McKinleyville, CA; Fortuna, CA; Ferndale, CA; Eureka, CA; Crescent City, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics Physician |
207VX0000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | 010000215 | CA | Yes |
Addresses
Primary practice location
550 E Washington Blvd
Crescent City, CA 95531-8342
Mailing address
1275 8TH St
Arcata, CA 95521-5770
Phone (707) 826-8633
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC03919F | Medicaid | CA |
Other names
- Del Norte Community Health Center
Other providers in Crescent City, CA
- North Coast Family Counseling LLC
- Northshore Investments, Inc.
- Elizabeth Novicky
- Brie-Janae Lynn Oliver
- Open Door Community Health Centers
- Griselda Orat
- Alissa Michelle Oulman-Kirkpatrick
- Frank Oxford
- Pacific Coast Allergy
- Pacific Northwest Physical Therapy
All providers in Crescent City, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.