=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326537234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONARCH LIFEWORKS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2018
-----------------------------------------------------
Last Update Date | 11/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2433 S BELVOIR BLVD
-----------------------------------------------------
City | UNIVERSITY HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-4650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-320-8222
-----------------------------------------------------
Fax | 216-320-8733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22001 FAIRMOUNT BLVD
-----------------------------------------------------
City | SHAKER HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118-4819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-320-8222
-----------------------------------------------------
Fax | 216-320-8733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL COUNSEL
-----------------------------------------------------
Name | LEIGH HALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-320-8222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number | TEMPORARY
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------