Organization
BELLEFAIRE JCB
Active
Parent organization
WINGSPAN CARE GROUP
Other names
Monarch Boarding Academy - South
Organization subpart
Yes
Provider details
NPI number
Legal business name
WINGSPAN CARE GROUP
Authorized official
MR. THOMAS J BROWNE (CFO)
(216) 320-8221
Entity
Organization
Contact information
Practice address
22001 FAIRMOUNT BLVD, SHAKER HEIGHTS, OH 44118-4819
(216) 932-2800
(216) 932-6704
Mailing address
22001 FAIRMOUNT BLVD, SHAKER HEIGHTS, OH 44118-4819
(216) 932-2800
(216) 932-6704
Taxonomy
Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
06-7516
OH
261QD1600X
Developmental Disabilities Clinic/Center
06-7516
OH
261QM0855X
Adolescent and Children Mental Health Clinic/Center
06-7516
OH
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
06-7516
OH
320800000X
Mental Illness Community Based Residential Treatment Facility
06-7516
OH
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
06-7516
OH
323P00000X
Psychiatric Residential Treatment Facility
06-7516
OH
385HR2055X
Child Mental Illness Respite Care
06-7516
OH
385HR2065X
Child Physical Disabilities Respite Care
06-7516
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02447
UPIN
OH
05
—
0525337
—
OH
01
—
2419958
MRDD-ODJFS
OH
05
—
2847183
—
OH
05
—
2864226
—
OH
Enumeration date
04/15/2015
Last updated
04/15/2015
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