Provider Demographics
NPI:1528307055
Name:MONARCH LIFEWORKS
Entity type:Organization
Organization Name:MONARCH LIFEWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-932-2800
Mailing Address - Street 1:3205 FAIRMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4211
Mailing Address - Country:US
Mailing Address - Phone:216-321-6744
Mailing Address - Fax:
Practice Address - Street 1:3205 FAIRMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4211
Practice Address - Country:US
Practice Address - Phone:216-321-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLEFAIRE JCB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-04
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1819198251C00000X, 261QA0600X, 283X00000X, 343900000X, 251S00000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No283X00000XHospitalsRehabilitation Hospital
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078929Medicaid
OH1819198OtherDEPARTMENT OF DEVELOPMENTAL DISABILITIES