Healthcare Provider Details

I. General information

NPI: 1013940949
Provider Name (Legal Business Name): NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 MILES AVE
CLEVELAND OH
44105-5521
US

IV. Provider business mailing address

8300 HOUGH AVE
CLEVELAND OH
44103-4247
US

V. Phone/Fax

Practice location:
  • Phone: 216-751-3100
  • Fax: 216-751-2480
Mailing address:
  • Phone: 213-231-7700
  • Fax: 216-231-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. WILLIE F AUSTIN
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 216-231-7700