NPIMap

Organization Active NPI

Monarch Lifeworks

  • Intellectual Disabilities Intermediate Care Facility
  • Shaker Heights, OH
National Provider Identifier
1871950709
Registry record updated Jun 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
MONARCH LIFEWORKS
Practice address
21450 Fairmount Blvd
Shaker Heights, OH 44118-4808
Phone
(216) 371-5051
Fax
(216) 932-6704
NPI assigned
Jan 22, 2016
Organization subpart
Yes
Parent organization
BELLEFAIRE JCBAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Adam G Jacobs, PH.D.
Title
President
Phone
(216) 932-2800

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 31712 OH
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 31712 OH

Addresses

Primary practice location

21450 Fairmount Blvd
Shaker Heights, OH 44118-4808

Mailing address

21450 Fairmount Blvd
Shaker Heights, OH 44118-4808
Phone (216) 371-5051

Other identifiers 3

IdentifierTypeStateIssuer
31712OtherOHOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES CERTIFICATE NUMBER
0078929MedicaidOH
1815525OtherOHOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES FACILITY NUMBER

Other names 1

  • Monarch Lifeworks - Xanthos Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G709

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
XANTHOS HOUSE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Apr 4, 2016
Last certification
Oct 22, 2024
Beds
6
Ownership / control type
Private (non-profit)
Facility address
21450 Fairmount Blvd
Shaker Heights, OH 44118

National Provider Directory

National Provider Directory
Tax ID family
Monarch Lifeworks6 organizations share this tax ID, including this one
Part of
Bellefaire Jewish Children'S Bureau

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560816000000",
    "number": "1871950709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21450 FAIRMOUNT BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441184808",
            "telephone_number": "216-371-5051",
            "fax_number": "216-932-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21450 FAIRMOUNT BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441184808",
            "telephone_number": "216-371-5051",
            "fax_number": "216-932-6704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONARCH LIFEWORKS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BELLEFAIRE JCB",
        "enumeration_date": "2016-01-22",
        "last_updated": "2019-06-18",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-932-2800",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OH",
            "license": "31712",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "31712",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES CERTIFICATE NUMBER",
            "identifier": "31712",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0078929",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES FACILITY NUMBER",
            "identifier": "1815525",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monarch Lifeworks - Xanthos",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Monarch Lifeworks - Xanthos",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shaker Heights, OH

Sources for this page

Verify at the official NPI Registry.