Provider Demographics
NPI:1518089762
Name:NEIGHBORHOOD HEALTH ASSOCIATION OF TOLEDO, INC.
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTH ASSOCIATION OF TOLEDO, INC.
Other - Org Name:CORDELIA MARTIN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER-CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-720-7883
Mailing Address - Street 1:313 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1004
Mailing Address - Country:US
Mailing Address - Phone:419-720-7883
Mailing Address - Fax:419-720-7895
Practice Address - Street 1:430 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-8540
Practice Address - Country:US
Practice Address - Phone:419-255-7883
Practice Address - Fax:419-255-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01403OtherPARAMOUNT
OH0824228Medicaid
OH361823Medicare Oscar/Certification
OH0824228Medicaid