Healthcare Provider Details

I. General information

NPI: 1538667829
Provider Name (Legal Business Name): 17TH ST LEASING CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 17TH ST NW
CANTON OH
44708-6004
US

IV. Provider business mailing address

10123 ALLIANCE RD
BLUE ASH OH
45242-4887
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-6508
  • Fax:
Mailing address:
  • Phone: 513-530-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLES STOLTZ
Title or Position: SECRETARY / TREASURER
Credential:
Phone: 513-530-1808