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NPI Code Detail

MEDICARE: 27TH STREET LEASING CO., LLC

MEDICARE: 27TH STREET 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1992444145
Entity Type Code : Organization
Provider Name (Legal Business Name) : 27TH STREET 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 : 1600 27TH ST
Second Line :
City : PARKERSBURG
State : WV
Zip : 26101-2815
Country : US
Telephone Number : 304-485-6476
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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