MEDICARE: ST LEONARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	1887	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851387047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LEONARD

Provider Business Mailing Address
First Line	:	8100 CLYO RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-2720
Country	:	US
Telephone Number	:	937-436-6317
Fax Number	:	937-439-7104

Provider Business Practice Location Address
First Line	:	8100 CLYO RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-2720
Country	:	US
Telephone Number	:	937-436-6317
Fax Number	:	937-439-7104

Authorized Official
Title or Position	:	CONTROLLER
Name	:	SYLVIA CLASEN
Credential	:
Telephone Number	:	937-439-7159

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	08/22/2020

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Practice Location Address:

8100 CLYO RD
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1548252893 — DR. WILLIAM FISH MARSTELLER III D.C.
Practice Location Address:

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1699767921 — HEATHER MORGAN MD INC
Practice Location Address:

138 S MAIN ST
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Directions to “ST LEONARD ” Practice Location

Language	Start Address	Practice Location

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