Organization
BELLEFAIRE JCB
Active
Parent organization
WINGSPAN CARE GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
WINGSPAN CARE GROUP
Authorized official
LEIGH C HALL (GENERAL COUNSEL)
(216) 320-8222
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
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
02447
OH
324500000X
Substance Abuse Rehabilitation Facility
02447
OH
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
02447
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02447
—
OH
05
—
10415
—
OH
Enumeration date
05/10/2012
Last updated
01/20/2023
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