Provider Demographics
NPI:1053863613
Name:NORTHWEST ADULT SERVICES LLC
Entity Type:Organization
Organization Name:NORTHWEST ADULT SERVICES LLC
Other - Org Name:NORTHWEST ADULT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILTIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-808-1640
Mailing Address - Street 1:6435 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5421
Mailing Address - Country:US
Mailing Address - Phone:513-493-2544
Mailing Address - Fax:800-864-3906
Practice Address - Street 1:6435 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5421
Practice Address - Country:US
Practice Address - Phone:513-493-2544
Practice Address - Fax:800-864-3906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST ADULT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-31
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3925642385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0179002Medicaid