NPIMap

Organization Active NPI

Open Door Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Eureka, CA
National Provider Identifier
1770229882
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPEN DOOR COMMUNITY HEALTH CENTERS
Practice address
3696 Jacobs Ave
Eureka, CA 95501-0911
Phone
(707) 443-4666
NPI assigned
May 11, 2022
Organization subpart
Yes
Parent organization
OPEN DOOR COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Authorized official

Name
Victor Starr
Title
President and Executive Officer
Phone
(707) 826-8633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3696 Jacobs Ave
Eureka, CA 95501-0911

Mailing address

1275 8TH St
Arcata, CA 95521-5770
Phone (707) 826-8633

Other names 1

  • Second Mobile Unit Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 551981

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SECOND MOBILE UNIT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 26, 2004
Last certification
Jul 26, 2004
Ownership / control type
For profit – partnership
Facility address
3696 Jacobs Avenue
Eureka, CA 95501

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2273424Second Mobile Unit3696 Jacobs Ave, Eureka, CA 95501Provider-performed microscopyDec 12, 2026

National Provider Directory

National Provider Directory
Tax ID family
Smith River Community11 organizations share this tax ID, including this one
Part of
Smith River Community

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3696 Jacobs Ave
Eureka, CA 95501
Phone (707) 443-4666

NPI Registry JSON

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

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1770229882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 8TH ST",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955215770",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3696 JACOBS AVE",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955010911",
            "telephone_number": "707-443-4666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPEN DOOR COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2022-05-11",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "STARR",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT AND EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-826-8633"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Second Mobile Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Second Mobile Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.