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General NPI Number Information
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NPI Number | 1972810398
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Entity Type | Organization
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Legal Business Name | NORTHEAST OHIO APPLIED HEALTH (NOAH)
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 6834 W SHERRI DR
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City | MACEDONIA
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State | OH
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Zip | 44056-2440
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Country | US
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Telephone | 330-554-8598
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Fax |
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Provider Business Mailing Address
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Address Line | 8536 CROW DR SUITES 30 & 32
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City | MACEDONIA
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State | OH
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Zip | 44056-1900
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Country | US
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Telephone | 330-467-0085
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Fax | 330-467-0094
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR / CEO
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Name | MR. DARRYL MARC MASON
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Credential | LSW; LCDCIII
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Telephone | 330-467-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 201023700945
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License Number State | OH
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