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 JOHNSON (GENERAL COUNSEL)
(216) 320-8222
Entity
Organization
Contact information
Practice address
1865 N RIDGE RD E STE D-E, LORAIN, OH 44055-3300
(440) 324-5701
(440) 277-0459
Mailing address
22001 FAIRMOUNT BLVD, SHAKER HEIGHTS, OH 44118-4819
(216) 320-8222
(216) 320-8733
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
01-0009
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02447
—
OH
05
—
10415
—
OH
Enumeration date
05/03/2006
Last updated
02/23/2018
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