Provider Demographics
NPI:1598410185
Name:SIGNATURE COORDINATION & CONSULT
Entity Type:Organization
Organization Name:SIGNATURE COORDINATION & CONSULT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:G
Authorized Official - Last Name:STONOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-899-0954
Mailing Address - Street 1:1221 DELAWARE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4084
Mailing Address - Country:US
Mailing Address - Phone:954-899-0954
Mailing Address - Fax:
Practice Address - Street 1:1221 DELAWARE AVE FL 2
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4084
Practice Address - Country:US
Practice Address - Phone:954-899-0954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110134800Medicaid