1891287439 NPI number — NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.

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 1891287439 NPI number — NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
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:
1891287439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 PAYNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44103-2443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-231-7700
Provider Business Mailing Address Fax Number:
216-231-3828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10505 SAINT CLAIR AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44108-1973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-325-6556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2018

Additional Information

Authorized Official

Authorized Official Last Name:
AUSTIN
Authorized Official First Name:
WILLIE
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
216-231-7700

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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