Provider Demographics
NPI:1518395029
Name:NORTH COAST HEALTH
Entity type:Organization
Organization Name:NORTH COAST HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-228-7878
Mailing Address - Street 1:PO BOX 638347
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-8347
Mailing Address - Country:US
Mailing Address - Phone:440-808-3700
Mailing Address - Fax:440-808-3675
Practice Address - Street 1:16110 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3715
Practice Address - Country:US
Practice Address - Phone:216-228-7878
Practice Address - Fax:216-529-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092765Medicaid
OH0092765Medicaid