Provider Demographics
NPI:1497933857
Name:EAST WATER LEASING CO., LLC
Entity Type:Organization
Organization Name:EAST WATER LEASING CO., LLC
Other - Org Name:OAK GROVE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF A/R
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-489-7100
Mailing Address - Street 1:4700 ASHWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2465
Mailing Address - Country:US
Mailing Address - Phone:513-489-7100
Mailing Address - Fax:
Practice Address - Street 1:620 E WATER ST
Practice Address - Street 2:
Practice Address - City:DESHLER
Practice Address - State:OH
Practice Address - Zip Code:43516-1327
Practice Address - Country:US
Practice Address - Phone:419-278-6921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2815547Medicaid
365767Medicare Oscar/Certification
OH6091630001Medicare NSC