Healthcare Provider Details

I. General information

NPI: 1871950709
Provider Name (Legal Business Name): MONARCH LIFEWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21450 FAIRMOUNT BLVD
SHAKER HEIGHTS OH
44118-4808
US

IV. Provider business mailing address

21450 FAIRMOUNT BLVD
SHAKER HEIGHTS OH
44118-4808
US

V. Phone/Fax

Practice location:
  • Phone: 216-371-5051
  • Fax: 216-932-6704
Mailing address:
  • Phone: 216-371-5051
  • Fax: 216-932-6704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number31712
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number31712
License Number StateOH

VIII. Authorized Official

Name: ADAM G JACOBS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 216-932-2800