Organization
MONARCH LIFEWORKS
Active
Parent organization
BELLEFAIRE JCB
Other names
Monarch Lifeworks - Xanthos
Organization subpart
Yes
Provider details
NPI number
Legal business name
BELLEFAIRE JCB
Authorized official
ADAM G JACOBS PH.D. (PRESIDENT)
(216) 932-2800
Entity
Organization
Contact information
Practice address
21450 FAIRMOUNT BLVD, SHAKER HEIGHTS, OH 44118-4808
(216) 371-5051
(216) 932-6704
Mailing address
21450 FAIRMOUNT BLVD, SHAKER HEIGHTS, OH 44118-4808
(216) 371-5051
(216) 932-6704
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
31712
OH
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
31712
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0078929
—
OH
01
—
1815525
OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES FACILITY NUMBER
OH
01
—
31712
OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES CERTIFICATE NUMBER
OH
Enumeration date
01/22/2016
Last updated
06/18/2019
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