Provider Demographics
NPI:1548267008
Name:QUALITY HEALTHCARE OF NORTHEAST OHIO INC
Entity type:Organization
Organization Name:QUALITY HEALTHCARE OF NORTHEAST OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:ROBERTS-ATWATER
Authorized Official - Suffix:
Authorized Official - Credentials:DO PHD
Authorized Official - Phone:330-841-3902
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:PA
Mailing Address - Zip Code:16112-0555
Mailing Address - Country:US
Mailing Address - Phone:724-667-9596
Mailing Address - Fax:724-667-4100
Practice Address - Street 1:8747 SQUIRES LN NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1649
Practice Address - Country:US
Practice Address - Phone:330-841-3902
Practice Address - Fax:814-446-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007354R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3076415Medicaid
OH9340012Medicare PIN