Provider Demographics
NPI:1639675143
Name:JOANNA HOUSE II
Entity Type:Organization
Organization Name:JOANNA HOUSE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LASALLE
Authorized Official - Middle Name:NOREEN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CDCAIII, CPRS, SW
Authorized Official - Phone:234-678-9805
Mailing Address - Street 1:387 WEST BARTGES ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1931
Mailing Address - Country:US
Mailing Address - Phone:234-678-9805
Mailing Address - Fax:330-849-5051
Practice Address - Street 1:342 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-2165
Practice Address - Country:US
Practice Address - Phone:234-678-9805
Practice Address - Fax:330-849-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0262730Medicaid