Healthcare Provider Details

I. General information

NPI: 1689399024
Provider Name (Legal Business Name): NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E 222ND ST
EUCLID OH
44123-2033
US

IV. Provider business mailing address

4800 PAYNE AVE
CLEVELAND OH
44103-2443
US

V. Phone/Fax

Practice location:
  • Phone: 216-797-7800
  • Fax:
Mailing address:
  • Phone: 216-231-7700
  • Fax: 216-231-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIE F. AUSTIN SR.
Title or Position: PRESIDENT & CEO
Credential:
Phone: 216-231-7700