Provider Demographics
NPI:1821263476
Name:SIGNATURE HEALTH SERVICES OF MANSFIELD, LLC
Entity Type:Organization
Organization Name:SIGNATURE HEALTH SERVICES OF MANSFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLDSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-666-3810
Mailing Address - Street 1:1092 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2250
Mailing Address - Country:US
Mailing Address - Phone:419-589-5921
Mailing Address - Fax:419-589-5871
Practice Address - Street 1:2830 COPLEY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2142
Practice Address - Country:US
Practice Address - Phone:330-666-3810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGNATURE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2535448251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2535448Medicaid