Organization
HAZELWOOD HOUSE
Active
Organization
HAZELWOOD HOUSE
Active
Parent organization
LIFEWORKS NORTHWEST
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFEWORKS NORTHWEST
Authorized official
MARY MONNAT (PRESIDENT/CEO)
(503) 645-3581
Entity
Organization
Contact information
Practice address
5415 SW WESTGATE DR, PORTLAND, OR 97221-2409
(503) 645-3581
(503) 629-8517
Mailing address
5415 SW WESTGATE DR, PORTLAND, OR 97221-2409
(503) 645-3581
(503) 629-8517
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
512881
—
OR
Enumeration date
05/13/2009
Last updated
03/09/2022
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