Provider Demographics
NPI:1164123196
Name:NORTHWEST HUMAN SERVICES, INC.
Entity type:Organization
Organization Name:NORTHWEST HUMAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-588-5831
Mailing Address - Street 1:681 CENTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3722
Mailing Address - Country:US
Mailing Address - Phone:503-588-5828
Mailing Address - Fax:503-588-5823
Practice Address - Street 1:1143 LIBERTY ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1047
Practice Address - Country:US
Practice Address - Phone:503-588-5825
Practice Address - Fax:503-364-1027
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST HUMAN SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)