NPIMap

Organization Active NPI

Hazelwood House

  • Mental Illness Community Based Residential Treatment Facility
  • Portland, OR
National Provider Identifier
1508090994
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
HAZELWOOD HOUSE
Practice address
5415 SW Westgate Dr
Portland, OR 97221-2409
Phone
(503) 645-3581
Fax
(503) 629-8517
NPI assigned
May 13, 2009
Organization subpart
Yes
Parent organization
LIFEWORKS NORTHWESTAs reported in NPPES

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
Title
President/Ceo
Phone
(503) 645-3581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

5415 SW Westgate Dr
Portland, OR 97221-2409

Mailing address

5415 SW Westgate Dr
Portland, OR 97221-2409
Phone (503) 645-3581

Other identifiers 1

IdentifierTypeStateIssuer
512881MedicaidOR

National Provider Directory

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

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1508090994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5415 SW WESTGATE DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212409",
            "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 DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212409",
            "telephone_number": "503-645-3581",
            "fax_number": "503-629-8517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZELWOOD HOUSE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFEWORKS NORTHWEST",
        "enumeration_date": "2009-05-13",
        "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": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "503-645-3581"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "512881",
            "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.