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General NPI Number Information
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NPI Number | 1851387047
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Entity Type | Organization
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Legal Business Name | ST LEONARD
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8100 CLYO RD
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City | CENTERVILLE
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State | OH
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Zip | 45458-2720
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Country | US
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Telephone | 937-436-6317
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Fax | 937-439-7104
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Provider Business Mailing Address
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Address Line | 8100 CLYO RD
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City | CENTERVILLE
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State | OH
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Zip | 45458-2720
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Country | US
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Telephone | 937-436-6317
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Fax | 937-439-7104
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Authorized Official
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Title or Position | CONTROLLER
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Name | SYLVIA CLASEN
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Credential |
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Telephone | 937-439-7159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 1887
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License Number State | OH
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