Provider Demographics
NPI:1336516392
Name:LIFEWORKS NORTHWEST
Entity Type:Organization
Organization Name:LIFEWORKS NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED RECOVERY MENTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-282-3296
Mailing Address - Street 1:4838 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4941 NE 17TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-5709
Practice Address - Country:US
Practice Address - Phone:503-645-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management