Organization
RED DOOR RESIDENTIAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE LANE (CEO)
(740) 441-7163
Entity
Organization
Contact information
Practice address
300 2ND AVE # 1D, GALLIPOLIS, OH 45631-1163
(740) 441-7163
Mailing address
300 2ND AVE # 1D, GALLIPOLIS, OH 45631-1163
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
11/11/2020
Last updated
11/11/2020
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