Provider Demographics
NPI:1366700064
Name:NORTH EAST OHIO HEALTH SERVICES
Entity type:Organization
Organization Name:NORTH EAST OHIO HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-834-6466
Mailing Address - Street 1:24200 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5550
Mailing Address - Country:US
Mailing Address - Phone:216-831-6466
Mailing Address - Fax:216-766-0083
Practice Address - Street 1:24200 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5550
Practice Address - Country:US
Practice Address - Phone:216-831-6466
Practice Address - Fax:216-766-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2863834251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2863834Medicaid
OH9166922Medicare PIN