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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1396093597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	4800 PAYNE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-2443
Country	:	US
Telephone Number	:	216-231-7700
Fax Number	:	216-231-3828

Provider Business Practice Location Address
First Line	:	9127 MILES AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-6136
Country	:	US
Telephone Number	:	216-231-7700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	WILLIE F. AUSTIN
Credential	:
Telephone Number	:	216-231-7700

Provider Enumeration Date	:	08/17/2012
Last Update Date	:	08/17/2012

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