MEDICARE: NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1124487681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	9127 MILES AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-6136
Country	:	US
Telephone Number	:	216-325-6544
Fax Number	:	216-441-3968

Provider Business Practice Location Address
First Line	:	9127 MILES AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-6136
Country	:	US
Telephone Number	:	216-325-6544
Fax Number	:	216-441-3968

Authorized Official
Title or Position	:	PRESIDENT & CE)
Name	:	WILLIE F AUSTIN SR.
Credential	:
Telephone Number	:	216-231-7700

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	02/12/2016

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