Provider Demographics
NPI:1053342766
Name:SIGNATURE HEALTH SERVICES-AKRON LLC
Entity type:Organization
Organization Name:SIGNATURE HEALTH SERVICES-AKRON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-666-3810
Mailing Address - Street 1:441 WOLF LEDGES PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1030
Mailing Address - Country:US
Mailing Address - Phone:330-374-5633
Mailing Address - Fax:330-374-0560
Practice Address - Street 1:441 WOLF LEDGES PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1030
Practice Address - Country:US
Practice Address - Phone:330-374-5633
Practice Address - Fax:330-374-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2516549251E00000X
OH368104251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2516549Medicaid
36Q8104001Medicare Oscar/Certification
OH368104Medicare ID - Type UnspecifiedPROVIDER NUMBER