MEDICARE: WYOMING 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	:	1811570955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYOMING 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	:	2025 WYOMING AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1112
Country	:	US
Telephone Number	:	513-251-2557
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	04/30/2025

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