=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770644668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARADOX NORTHWEST ASSOCIATES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 E 11TH ST SUITE LL1
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98660-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-992-5956
-----------------------------------------------------
Fax | 360-992-5958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 E 11TH ST SUITE LL1
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98660-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-992-5956
-----------------------------------------------------
Fax | 360-992-5958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. TED ALBY
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 360-992-5956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | IS-007
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------