Basic Information
| Provider Information | |||||||||
| NPI: | 1306117395 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFEWORKS NW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14600 NW CORNELL RD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972295442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036453581 | ||||||||
| FaxNumber: | 5036909605 | ||||||||
| Practice Location | |||||||||
| Address1: | 12350 SW 5TH ST | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970052819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036279194 | ||||||||
| FaxNumber: | 5036909805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2012 | ||||||||
| LastUpdateDate: | 01/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | LOVENBURG | ||||||||
| AuthorizedOfficialFirstName: | JOCELYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | HR SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5038453581 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | OR | Y | Agencies | Case Management |
No ID Information.