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General NPI Number Information
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NPI Number | 1437346517
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Entity Type | Organization
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Legal Business Name | NORTHWEST ORGANIZATION FOR VOLUNTARY ALTERNATIVES
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 5801 NORTH 51ST AVENUE SUITE 109
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City | GLENDALE
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State | AZ
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Zip | 85301
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Country | US
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Telephone | 623-931-5810
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Fax | 623-931-1302
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Provider Business Mailing Address
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Address Line | 4425 WEST OLIVE AVENUE SUITE 200
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City | GLENDALE
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State | AZ
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Zip | 85302
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Country | US
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Telephone | 623-937-9203
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Fax | 623-930-0358
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Authorized Official
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Title or Position | ACTING DIRECTOR
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Name | MR. EDWARD WILLIAM PINNOW
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Credential |
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Telephone | 623-937-9203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | BH 406
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License Number State | AZ
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