Provider Demographics
NPI:1871950709
Name:MONARCH LIFEWORKS
Entity type:Organization
Organization Name:MONARCH LIFEWORKS
Other - Org Name:<UNAVAIL>
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 1:21450 FAIRMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4808
Mailing Address - Country:US
Mailing Address - Phone:216-371-5051
Mailing Address - Fax:216-932-6704
Practice Address - Street 1:21450 FAIRMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4808
Practice Address - Country:US
Practice Address - Phone:216-371-5051
Practice Address - Fax:216-932-6704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLEFAIRE JCB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-22
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31712251S00000X, 320600000X
315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31712OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES CERTIFICATE NUMBER
OH0078929Medicaid
OH1815525OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES FACILITY NUMBER