Provider Demographics
NPI:1730639816
Name:OUT WEST PROPERTIES, INC.
Entity Type:Organization
Organization Name:OUT WEST PROPERTIES, INC.
Other - Org Name:STEWART HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART-WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-842-1259
Mailing Address - Street 1:2411 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-4015
Mailing Address - Country:US
Mailing Address - Phone:503-842-1259
Mailing Address - Fax:
Practice Address - Street 1:2411 9TH ST
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-4015
Practice Address - Country:US
Practice Address - Phone:503-842-1259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEWART HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR507204251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR507204Medicaid