| Green Door, Inc. | |
|
1221 Taylor St Nw Washington DC 20011-5617 | |
| (202) 464-9200 | |
| (202) 464-5740 |
| Full Name | Green Door, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1221 Taylor St Nw, Washington, District Of Columbia |
| Authorized Official Name and Position | Michael Clancy (DEPUTY DIRECTOR) |
| Authorized Official Contact | 2024649200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Door, Inc. 1221 Taylor St Nw Washington DC 20011-5617 Ph: (202) 464-9200 | Green Door, Inc. 1221 Taylor St Nw Washington DC 20011-5617 Ph: (202) 464-9200 |
| NPI Number | 1073659140 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073659140 | NPI | - | NPPES |
| 23653 | Other | DC | CHARTERED HEALTH PLAN |
| 281810 | Other | DC | AMERIGROUP (MEDICAID MCO) |
| 5181 | Other | DC | HEALTHRIGHT (MEDICAID MCO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD33367 (District Of Columbia) | Primary |
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