Provider Demographics
NPI:1750907960
Name:TANDEM NORTHWEST, INC.
Entity type:Organization
Organization Name:TANDEM NORTHWEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCARTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-428-5233
Mailing Address - Street 1:101 PINE ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:503-589-4901
Practice Address - Street 1:348 DENNIS LN N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5936
Practice Address - Country:US
Practice Address - Phone:503-589-4901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10456Medicaid