Provider Demographics
NPI:1770974461
Name:FAITH OPEN DOOR COMMUNITY CENTER, INC.
Entity type:Organization
Organization Name:FAITH OPEN DOOR COMMUNITY CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-545-6053
Mailing Address - Street 1:259 ARROWHEAD BLVD
Mailing Address - Street 2:C2
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1167
Mailing Address - Country:US
Mailing Address - Phone:678-545-6053
Mailing Address - Fax:678-545-6119
Practice Address - Street 1:259 ARROWHEAD BLVD
Practice Address - Street 2:C2
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1167
Practice Address - Country:US
Practice Address - Phone:678-545-6053
Practice Address - Fax:678-545-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty