MEDICARE: NORTHWEST HUMAN SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1871530758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST HUMAN SERVICES, INC.

Provider Business Mailing Address
First Line	:	681 CENTER ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3722
Country	:	US
Telephone Number	:	503-588-5828
Fax Number	:	503-588-5852

Provider Business Practice Location Address
First Line	:	1233 EDGEWATER ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-4049
Country	:	US
Telephone Number	:	503-378-7526
Fax Number	:	503-480-1630

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. PAUL LOGAN
Credential	:
Telephone Number	:	503-588-5831

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/13/2023

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