Provider Demographics
NPI:1497843080
Name:NORTHWEST COUNTRY PLACE INC
Entity Type:Organization
Organization Name:NORTHWEST COUNTRY PLACE INC
Other - Org Name:OAKWOOD HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ODEGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-472-3141
Mailing Address - Street 1:421 SE EVANS ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6111
Mailing Address - Country:US
Mailing Address - Phone:503-472-3141
Mailing Address - Fax:503-472-9334
Practice Address - Street 1:421 SE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6111
Practice Address - Country:US
Practice Address - Phone:503-472-3141
Practice Address - Fax:503-472-9334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST COUNTRY PLACE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-1202251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR387108Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER