Organization
INDIANA LEASING CO., LLC
Active
Other names
Grande Lake Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES R STOLTZ (CFO)
(513) 530-1613
Entity
Organization
Contact information
Practice address
1209 INDIANA AVE, SAINT MARYS, OH 45885-1310
(419) 394-7611
Mailing address
4700 ASHWOOD DR STE 200, BLUE ASH, OH 45241-2424
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/06/2021
Last updated
08/06/2021
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