Provider Demographics
NPI:1972810398
Name:NORTHEAST OHIO APPLIED HEALTH (NOAH)
Entity type:Organization
Organization Name:NORTHEAST OHIO APPLIED HEALTH (NOAH)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW; LCDCIII
Authorized Official - Phone:330-467-0085
Mailing Address - Street 1:8536 CROW DR
Mailing Address - Street 2:SUITES 30 & 32
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1900
Mailing Address - Country:US
Mailing Address - Phone:330-467-0085
Mailing Address - Fax:330-467-0094
Practice Address - Street 1:6834 W SHERRI DR
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2440
Practice Address - Country:US
Practice Address - Phone:330-554-8598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201023700945251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health