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General NPI Number Information
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NPI Number | 1629843834
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Entity Type | Organization
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Legal Business Name | SIGNATURE HEALTH, INC.
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 3001 PROSPECT AVENUE
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City | CLEVELAND
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State | OH
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Zip | 44115
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Country | US
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Telephone | 440-578-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 7232 JUSTIN WAY
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City | MENTOR
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State | OH
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Zip | 44060-4881
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Country | US
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Telephone | 440-578-8200
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN ALBERT LEE
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Credential |
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Telephone | 440-578-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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