Provider Demographics
NPI:1346795853
Name:SIGNATURE HEALTH
Entity Type:Organization
Organization Name:SIGNATURE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-663-6100
Mailing Address - Street 1:5410 TRANSPORTATION BLVD.SUITE 4
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:UNITED STATES
Mailing Address - Zip Code:44125
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5410 TRANSPORTATION BLVD.SUITE 4
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:UNITED STATES
Practice Address - Zip Code:44125
Practice Address - Country:UM
Practice Address - Phone:216-663-6100
Practice Address - Fax:216-663-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 161212-M-IV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health