Provider Demographics
NPI:1780411926
Name:NORTHWEST ELITE MENTAL HEALTH CLINIC
Entity type:Organization
Organization Name:NORTHWEST ELITE MENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER/ CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUADO
Authorized Official - Middle Name:ABSHIR
Authorized Official - Last Name:MADEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-601-8155
Mailing Address - Street 1:5109 SE 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-3816
Mailing Address - Country:US
Mailing Address - Phone:971-601-8155
Mailing Address - Fax:
Practice Address - Street 1:5109 SE 88TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-3816
Practice Address - Country:US
Practice Address - Phone:971-601-8155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)