Provider Demographics
NPI:1386634608
Name:SIGNATURE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:SIGNATURE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-666-3810
Mailing Address - Street 1:540 OFFICENTER PL
Mailing Address - Street 2:SUITE 295
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5317
Mailing Address - Country:US
Mailing Address - Phone:614-501-1879
Mailing Address - Fax:614-501-2934
Practice Address - Street 1:540 OFFICENTER PL
Practice Address - Street 2:SUITE 295
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5317
Practice Address - Country:US
Practice Address - Phone:614-501-1879
Practice Address - Fax:614-501-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH368015251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2535448Medicaid
OH2404624Medicaid
OH2535448Medicaid
OH36Q8015001Medicare ID - Type UnspecifiedMEDICARE BRANCH ID
OH2404624Medicaid
OH36Q8015003Medicare Oscar/Certification