Healthcare Provider Details

I. General information

NPI: 1679767289
Provider Name (Legal Business Name): SIGNATURE HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 TRANSPORTATION BLVD UNIT 4
GARFIELD HEIGHTS OH
44125-5380
US

IV. Provider business mailing address

38879 MENTOR AVE SUITE C
WILLOUGHBY OH
44094-7992
US

V. Phone/Fax

Practice location:
  • Phone: 216-663-6100
  • Fax: 216-663-7113
Mailing address:
  • Phone: 440-953-9999
  • Fax: 440-918-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number467
License Number StateOH

VIII. Authorized Official

Name: JONATHAN ALBERT LEE
Title or Position: CEO
Credential:
Phone: 440-953-9999