1972810398 NPI number — NORTHEAST OHIO APPLIED HEALTH (NOAH)

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972810398 NPI number — NORTHEAST OHIO APPLIED HEALTH (NOAH)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST OHIO APPLIED HEALTH (NOAH)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972810398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8536 CROW DR
Provider Second Line Business Mailing Address:
SUITES 30 & 32
Provider Business Mailing Address City Name:
MACEDONIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44056-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-467-0085
Provider Business Mailing Address Fax Number:
330-467-0094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6834 W SHERRI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACEDONIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44056-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-554-8598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
DARRYL
Authorized Official Middle Name:
MARC
Authorized Official Title or Position:
EXECUTIVE DIRECTOR / CEO
Authorized Official Telephone Number:
330-467-0085

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  201023700945 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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