Provider Demographics
NPI:1194237222
Name:ST LEONARD
Entity type:Organization
Organization Name:ST LEONARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:IFFLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-455-0414
Mailing Address - Street 1:5942 RENAISSANCE PL STE A
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4716
Mailing Address - Country:US
Mailing Address - Phone:567-455-0414
Mailing Address - Fax:
Practice Address - Street 1:8100 CLYO RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-2720
Practice Address - Country:US
Practice Address - Phone:937-433-0480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LEONARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home