Provider Demographics
NPI:1780806869
Name:NORTHWEST CENTER FOR OPTIMAL HEALTH INC
Entity type:Organization
Organization Name:NORTHWEST CENTER FOR OPTIMAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KASRA
Authorized Official - Middle Name:
Authorized Official - Last Name:POURNADEALI
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:360-651-9355
Mailing Address - Street 1:316 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-5028
Mailing Address - Country:US
Mailing Address - Phone:360-651-9355
Mailing Address - Fax:
Practice Address - Street 1:316 STATE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-5028
Practice Address - Country:US
Practice Address - Phone:360-651-9355
Practice Address - Fax:360-651-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory