Provider Demographics
NPI:1356477376
Name:NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-231-7700
Mailing Address - Street 1:8300 HOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4247
Mailing Address - Country:US
Mailing Address - Phone:216-231-7700
Mailing Address - Fax:216-231-7920
Practice Address - Street 1:8300 HOUGH AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4247
Practice Address - Country:US
Practice Address - Phone:216-231-7700
Practice Address - Fax:216-231-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0202636503336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0154845Medicaid
OH341014292-00OtherBWC PHARMACY
OH341014292-00OtherBWC PHARMACY