# OPEN DOOR GROUP HOME\#, INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184803686
- **Authorized official:** MS. BETTY ANN GRAVELY MAEDU (OWNER/DIRECTOR)
- **Authorized official phone:** (704) 739-6650

## Contact information

- **Practice address:** 140 SHADY GROVE RD, KINGS MOUNTAIN, NC 28086-9669
- **Practice address phone:** (704) 739-6650
- **Mailing address:** 140 SHADY GROVE RD, KINGS MOUNTAIN, NC 28086-9669
- **Mailing address phone:** (704) 739-6650

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL036249 | NC | Yes |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | MHL036249 | NC | — |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | MHL036249 | NC | — |

## Other

- **Enumeration date:** 10/31/2007
- **Last updated:** 10/31/2007