Healthcare Provider Details

I. General information

NPI: 1497933857
Provider Name (Legal Business Name): EAST WATER LEASING CO., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E WATER ST
DESHLER OH
43516-1327
US

IV. Provider business mailing address

4700 ASHWOOD DR SUITE 200
CINCINNATI OH
45241-2465
US

V. Phone/Fax

Practice location:
  • Phone: 419-278-6921
  • Fax:
Mailing address:
  • Phone: 513-489-7100
  • 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: MS. SANDRA K HUBBARD
Title or Position: DIRECTOR OF A/R
Credential:
Phone: 513-489-7100