Provider Demographics
NPI:1992883631
Name:NORTHWEST BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:NORTHWEST BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-722-4470
Mailing Address - Street 1:18000 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-1447
Mailing Address - Country:US
Mailing Address - Phone:503-722-4470
Mailing Address - Fax:503-722-4410
Practice Address - Street 1:18000 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-1447
Practice Address - Country:US
Practice Address - Phone:503-722-4470
Practice Address - Fax:503-722-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR323P00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility