Provider Demographics
NPI:1427316819
Name:NORTHEAST OHIO APPLIED HEALTH
Entity type:Organization
Organization Name:NORTHEAST OHIO APPLIED HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-467-0085
Mailing Address - Street 1:8536 CROW DR STE 30
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1900
Mailing Address - Country:US
Mailing Address - Phone:330-467-0085
Mailing Address - Fax:330-467-0094
Practice Address - Street 1:8536 CROW DR STE 30
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1900
Practice Address - Country:US
Practice Address - Phone:330-467-0085
Practice Address - Fax:330-467-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3115444Medicaid