Organization
BELLEFAIRE JCB
Active
Parent organization
WINGSPAN CARE GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
WINGSPAN CARE GROUP
Authorized official
THOMAS J BROWNE (CFO)
(216) 320-8221
Entity
Organization
Contact information
Practice address
347 MIDWAY BLVD, ELYRIA, OH 44035-9006
(440) 324-5701
(440) 324-9978
Mailing address
347 MIDWAY BLVD, ELYRIA, OH 44035-9006
(440) 324-5701
(440) 324-9978
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
0009
OH
324500000X
Substance Abuse Rehabilitation Facility
0009
OH
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
0009
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02477
—
OH
05
—
10415
—
OH
Enumeration date
05/11/2012
Last updated
05/17/2012
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