Provider Demographics
NPI:1205012549
Name:NORTHWESTER HUMAN SERVICES
Entity Type:Organization
Organization Name:NORTHWESTER HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CUSTOMER SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-247-6292
Mailing Address - Street 1:400 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2414
Mailing Address - Country:US
Mailing Address - Phone:215-368-2022
Mailing Address - Fax:215-855-6454
Practice Address - Street 1:400 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2414
Practice Address - Country:US
Practice Address - Phone:215-368-2022
Practice Address - Fax:215-855-6454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015769251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020074510001Medicaid