=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972781334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH III LEASING CO., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2008
-----------------------------------------------------
Last Update Date | 12/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8064 SOUTH AVE SUITE ONE
-----------------------------------------------------
City | BOARDMAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44512-6153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-965-6432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 ASHWOOD DR SUITE 200
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45241-2465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-489-7100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIR OF A/R
-----------------------------------------------------
Name | MS. SANDRA K HUBBARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-489-7100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number | 1440
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------