Healthcare Provider Details

I. General information

NPI: 1033927850
Provider Name (Legal Business Name): NORTHWEST COASTAL HOUSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 NE AVERY STREET SUITE #A
NEWPORT OR
97365-0011
US

IV. Provider business mailing address

PO BOX 1457
NEWPORT OR
97365-0011
US

V. Phone/Fax

Practice location:
  • Phone: 541-574-0320
  • Fax: 541-574-6170
Mailing address:
  • Phone: 541-574-0320
  • Fax: 541-574-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHEILA STILEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-574-0320