Healthcare Provider Details

I. General information

NPI: 1225619703
Provider Name (Legal Business Name): NORTHWEST IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 NW SHEVLIN PARK RD STE 110
BEND OR
97703-7134
US

IV. Provider business mailing address

6400 SE LAKE RD STE 155
PORTLAND OR
97222-2137
US

V. Phone/Fax

Practice location:
  • Phone: 541-728-2525
  • Fax: 971-223-0919
Mailing address:
  • Phone: 503-447-3285
  • Fax: 503-917-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN PERRY
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 971-358-9292