NPIMap

Organization Active NPI

Northeast Ohio Neighborhood Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Cleveland, OH
National Provider Identifier
1407874589
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Practice address
1468 E 55TH St
Cleveland, OH 44103-1307
Phone
(216) 881-2000
Fax
(216) 812-8124
NPI assigned
Jul 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Willie F. Austin
Title
President & Chief Executive Officer
Phone
(216) 231-7700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1468 E 55TH St
Cleveland, OH 44103-1307

Mailing address

8300 Hough Ave
Cleveland, OH 44103-4247
Phone (216) 231-7700

Other identifiers 1

IdentifierTypeStateIssuer
0850413MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050614001025 OH Part A Provider - Federally Qualified Health Center (FQHC) 5799756615 Practice locations: Cleveland, OH

Federally qualified health center certification: CCN 361833

Legal name
NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 23, 1967 in OH
Enrollment address
1468 E 55TH St
Cleveland, OH 44103-1307

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tenisha Gant-Watson Individual Corporate DirectorBoard Member Jan 1, 2015
Liang Chen Individual Corporate OfficerChief Financial Officer Jan 1, 2019
Karen Butler Individual Corporate OfficerChief Operating Officer Apr 1, 2014
W-2 Managing EmployeeChief Operating Officer Apr 1, 2014
Willie F Austin Individual Corporate OfficerCeo Mar 1, 2003
W-2 Managing Employee Nov 11, 2014
Phyllis Weeden-Oliver Individual Corporate DirectorBoard Member Jan 1, 2012
Stacie Spears Individual Corporate DirectorBoard Member Jan 1, 2012
Anita M Watson Individual Corporate DirectorMedical Director Jan 1, 2023
Audra Ameen Individual Corporate DirectorMember Board of Trustees Jan 1, 2007
Edward McGhee Individual Corporate DirectorMember Board of Trustees Mar 10, 2021

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1407874589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8300 HOUGH AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441034247",
            "telephone_number": "216-231-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 E 55TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441031307",
            "telephone_number": "216-881-2000",
            "fax_number": "216-812-8124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "AUSTIN",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "216-231-7700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0850413",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.