Provider Demographics
NPI:1992845382
Name:NORTHWEST REGIONAL EDUCATION SERVICE DISTRICT
Entity Type:Organization
Organization Name:NORTHWEST REGIONAL EDUCATION SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-614-1253
Mailing Address - Street 1:5825 NE RAY CIR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6436
Mailing Address - Country:US
Mailing Address - Phone:503-614-1667
Mailing Address - Fax:503-614-1608
Practice Address - Street 1:5825 NE RAY CIR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6436
Practice Address - Country:US
Practice Address - Phone:503-614-1667
Practice Address - Fax:503-614-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR210382Medicaid