Healthcare Provider Details

I. General information

NPI: 1477575348
Provider Name (Legal Business Name): SIGNATURE HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38876 MENTOR AVE
WILLOUGHBY OH
44094-7931
US

IV. Provider business mailing address

38876 MENTOR AVE
WILLOUGHBY OH
44094-7931
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-9999
  • Fax: 440-918-3839
Mailing address:
  • Phone: 440-953-9999
  • Fax: 440-918-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0467
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

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