MEDICARE: ST LEONARD

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	:	1710713045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LEONARD

Provider Business Mailing Address
First Line	:	8100 CLYO RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-2720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8100 CLYO RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-2720
Country	:	US
Telephone Number	:	937-433-0480
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF ANCILLARY CONTRACTING
Name	:	MATTHEW WINE
Credential	:
Telephone Number	:	513-562-7202

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	09/12/2024

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Directions to “ST LEONARD ” Practice Location

Language	Start Address	Practice Location

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