Provider Demographics
NPI:1295401040
Name:NEIGHBORHOOD HEALTH CARE INCORPORATED
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTH CARE INCORPORATED
Other - Org Name:NEIGHBORHOOD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-281-8945
Mailing Address - Street 1:4115 BRIDGE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3304
Mailing Address - Country:US
Mailing Address - Phone:216-281-0872
Mailing Address - Fax:216-961-5429
Practice Address - Street 1:14306 DETROIT AVE RM A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4417
Practice Address - Country:US
Practice Address - Phone:216-281-0872
Practice Address - Fax:216-961-5429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04530076Medicaid