1215110994 NPI number — GARDEN II LEASING CO., LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215110994 NPI number — GARDEN II LEASING CO., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARDEN II LEASING CO., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED SPECIALTY HOSPITAL OF TOLEDO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215110994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10123 ALLIANCE RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE ASH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-4714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-489-7100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 GARDEN LAKE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43614-2779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-381-0037
Provider Business Practice Location Address Fax Number:
419-381-3990
Provider Enumeration Date:
12/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOLTZ
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
BOARD MEMBER
Authorized Official Telephone Number:
513-530-1613

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  1477 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X , with the licence number: 1477 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2973715 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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