MEDICARE: SENECA TRAIL LEASING CO., LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1265171540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENECA TRAIL LEASING CO., LLC

Provider Business Mailing Address
First Line	:	10123 ALLIANCE RD
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45242-4887
Country	:	US
Telephone Number	:	513-530-1808
Fax Number	:

Provider Business Practice Location Address
First Line	:	10797 SENECA TRL S
Second Line	:
City	:	LINDSIDE
State	:	WV
Zip	:	24951-7345
Country	:	US
Telephone Number	:	304-753-4332
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	CHARLES STOLTZ
Credential	:
Telephone Number	:	513-530-1808

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	05/01/2025

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