Provider Demographics
NPI:1124270723
Name:SARAH LEASURE
Entity type:Organization
Organization Name:SARAH LEASURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:LEASURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-243-2640
Mailing Address - Street 1:14056 MAPLE RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:MILFORD CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43045
Mailing Address - Country:US
Mailing Address - Phone:937-243-2640
Mailing Address - Fax:
Practice Address - Street 1:14056 MAPLE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:MILFORD CENTER
Practice Address - State:OH
Practice Address - Zip Code:43045
Practice Address - Country:US
Practice Address - Phone:937-243-2640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN1258663140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric