Provider Demographics
NPI:1962958439
Name:NORTHWEST RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:NORTHWEST RECOVERY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPNMENT
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-668-8008
Mailing Address - Street 1:1122 NE 122ND AVE
Mailing Address - Street 2:A102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2081
Mailing Address - Country:US
Mailing Address - Phone:509-668-8008
Mailing Address - Fax:
Practice Address - Street 1:1122 NE 122ND AVE
Practice Address - Street 2:A102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2081
Practice Address - Country:US
Practice Address - Phone:509-668-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility