Provider Demographics
NPI:1861561375
Name:NORTHWEST ORGANIZATION FOR VOLUNTARY ALTERNATIVES
Entity type:Organization
Organization Name:NORTHWEST ORGANIZATION FOR VOLUNTARY ALTERNATIVES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-937-9203
Mailing Address - Street 1:4425 W OLIVE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3843
Mailing Address - Country:US
Mailing Address - Phone:623-937-9203
Mailing Address - Fax:623-930-0358
Practice Address - Street 1:4425 W OLIVE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3843
Practice Address - Country:US
Practice Address - Phone:623-937-9203
Practice Address - Fax:623-930-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3380251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health