Provider Demographics
NPI:1952417891
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 1:15322 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-3043
Mailing Address - Country:US
Mailing Address - Phone:216-851-1500
Mailing Address - Fax:216-851-0602
Practice Address - Street 1:15322 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3043
Practice Address - Country:US
Practice Address - Phone:216-851-1500
Practice Address - Fax:216-851-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0159948Medicaid
OH3618341Medicare PIN