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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770594269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	8300 HOUGH AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-4247
Country	:	US
Telephone Number	:	216-231-7700
Fax Number	:	216-231-7920

Provider Business Practice Location Address
First Line	:	15201 EUCLID AVE
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-2803
Country	:	US
Telephone Number	:	216-541-5600
Fax Number	:	216-541-5658

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	04/11/2008

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