NPIMap

Organization Active NPI

Lifeworks Northwest

  • Adult Care Home Facility
  • Portland, OR
National Provider Identifier
1295043982
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
LIFEWORKS NORTHWEST
Practice address
5415 SW Westgate Drive
Portland, OR 97221-2406
Phone
(503) 645-3581
Fax
(503) 629-8517
NPI assigned
Sep 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Monnat, MA, LPC, CADCIII
Title
Ceo
Phone
(503) 645-3581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X Primary

Addresses

Primary practice location

5415 SW Westgate Drive
Portland, OR 97221-2406

Mailing address

5415 SW Westgate Drive
Portland, OR 97221-2406
Phone (503) 645-3581

Other identifiers 1

IdentifierTypeStateIssuer
500621571MedicaidOR

National Provider Directory

National Provider Directory
Tax ID family
Tualatin Vly MNTL HLTH6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14600 NW Cornell Rd
Portland, OR 97229

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1295043982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5415 SW WESTGATE DRIVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212406",
            "telephone_number": "503-645-3581",
            "fax_number": "503-629-8517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 SW WESTGATE DRIVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212406",
            "telephone_number": "503-645-3581",
            "fax_number": "503-629-8517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEWORKS NORTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-16",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "MONNAT",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-645-3581",
        "authorized_official_credential": "MA, LPC, CADCIII"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500621571",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.