Provider Demographics
NPI:1679767289
Name:SIGNATURE HEALTH, INC.
Entity Type:Organization
Organization Name:SIGNATURE HEALTH, INC.
Other - Org Name:NORTH COAST STUDENT ASSISTANCE, CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-953-9999
Mailing Address - Street 1:38879 MENTOR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7992
Mailing Address - Country:US
Mailing Address - Phone:440-953-9999
Mailing Address - Fax:440-918-3839
Practice Address - Street 1:5410 TRANSPORTATION BLVD
Practice Address - Street 2:UNIT 4
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5380
Practice Address - Country:US
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:2007-08-28
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH467101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9321321Medicare PIN