Organization
FIRST DOOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MODEIRA JOHNSON SR. (OWNER/CEO/PRESIDENT)
(248) 877-8401
Entity
Organization
Contact information
Practice address
25584 W 10 MILE RD, SOUTHFIELD, MI 48033-4826
(248) 877-8401
(313) 454-3102
Mailing address
25584 W 10 MILE RD, SOUTHFIELD, MI 48033-4826
(248) 877-8401
(313) 454-3102
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
—
—
311Z00000X
Custodial Care Facility
Primary
AS630369663
MI
311ZA0620X
Adult Care Home Facility
AS630369663
MI
314000000X
Skilled Nursing Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
AS630369663
MI
320800000X
Mental Illness Community Based Residential Treatment Facility
AS630369663
MI
385H00000X
Respite Care
AS630369663
MI
Other
Enumeration date
10/17/2016
Last updated
11/13/2018
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