Provider Demographics
NPI:1063533164
Name:NEIGHBORHOOD HEALTH ASSOCIATION OF TOLEDO, INC
Entity type:Organization
Organization Name:NEIGHBORHOOD HEALTH ASSOCIATION OF TOLEDO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER-CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-720-7883
Mailing Address - Street 1:313 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1004
Mailing Address - Country:US
Mailing Address - Phone:419-720-7883
Mailing Address - Fax:419-720-7895
Practice Address - Street 1:117 MAIN STREET
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2091
Practice Address - Country:US
Practice Address - Phone:419-691-1322
Practice Address - Fax:419-720-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0829367Medicaid
OH02137OtherPARAMOUNT
OH361837Medicare Oscar/Certification
OH361837Medicare Oscar/Certification