Provider Demographics
NPI:1700467966
Name:NORTHWEST HABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:NORTHWEST HABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAHUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-319-4054
Mailing Address - Street 1:3880 SE 8TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3772
Mailing Address - Country:US
Mailing Address - Phone:503-284-4440
Mailing Address - Fax:
Practice Address - Street 1:3880 SE 8TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3772
Practice Address - Country:US
Practice Address - Phone:503-284-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty