Healthcare Provider Details

I. General information

NPI: 1366988800
Provider Name (Legal Business Name): MONARCH LIFEWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 GREEN RD
SHAKER HEIGHTS OH
44122-2135
US

IV. Provider business mailing address

2675 GREEN RD
SHAKER HEIGHTS OH
44122-2135
US

V. Phone/Fax

Practice location:
  • Phone: 216-765-0601
  • Fax: 216-765-0611
Mailing address:
  • Phone: 216-765-0601
  • Fax: 216-765-0611

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 Number32471
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number32471
License Number StateOH

VIII. Authorized Official

Name: LEIGH JOHNSON
Title or Position: GENERAL COUNSEL
Credential:
Phone: 216-320-8222