Organization
INDIANA LEASING CO., LLC
Active
Other names
Grande Lake Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES STOLTZ (SECRETARY / TREASURER)
(513) 530-1808
Entity
Organization
Contact information
Practice address
1209 INDIANA AVE, SAINT MARYS, OH 45885-1310
(419) 394-7611
Mailing address
10123 ALLIANCE RD, BLUE ASH, OH 45242-4887
(513) 530-1808
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
01/26/2018
Last updated
05/01/2025
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