MEDICARE: MONARCH LIFEWORKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	32471	OH
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	32471	OH
3	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1815782	OTHER	OH	OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES FACILITY NUMBER
3	32471	OTHER	OH	OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES CERTIFICATE NUMBER

General Provider Information

NPI Number	:	1366988800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONARCH LIFEWORKS

Provider Business Mailing Address
First Line	:	2675 GREEN RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-2135
Country	:	US
Telephone Number	:	216-765-0601
Fax Number	:	216-765-0611

Provider Business Practice Location Address
First Line	:	2675 GREEN RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-2135
Country	:	US
Telephone Number	:	216-765-0601
Fax Number	:	216-765-0611

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	LEIGH JOHNSON
Credential	:
Telephone Number	:	216-320-8222

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	06/18/2019

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Directions to “MONARCH LIFEWORKS ” Practice Location

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