=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326835984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NESSA HEALTH OH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2025
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26250 EUCLID AVE STE 914
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44132-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-373-2113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | C/O HEYMANS LLC 10290 WEST ATLANTIC AVENUE #480065
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-866-3663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | JONATHAN LINDENBLATT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-866-3663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------