1245516939 NPI number — OPEN DOOR CLINIC

Table of content: RUTH ELIZABETH JURADO (NPI 1972119212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245516939 NPI number — OPEN DOOR CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN DOOR CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245516939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
164 DIVISION ST
Provider Second Line Business Mailing Address:
STE #607
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60120-5587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-695-1093
Provider Business Mailing Address Fax Number:
847-695-0501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 S LINCOLN AVE
Provider Second Line Business Practice Location Address:
STE. #K
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60505-4264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-264-1819
Provider Business Practice Location Address Fax Number:
630-264-2054
Provider Enumeration Date:
10/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WINTER
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
630-264-1819

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com