Provider Demographics
NPI:1861483430
Name:HERITAGE OHIO LEASING CO., LLC
Entity Type:Organization
Organization Name:HERITAGE OHIO LEASING CO., LLC
Other - Org Name:COPLEY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR 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:513-530-1327
Mailing Address - Street 1:10123 ALLIANCE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4714
Mailing Address - Country:US
Mailing Address - Phone:513-530-1808
Mailing Address - Fax:
Practice Address - Street 1:155 HERITAGE WOODS DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1398
Practice Address - Country:US
Practice Address - Phone:330-666-0980
Practice Address - Fax:330-666-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1619N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2564541Medicaid
OH365771Medicare ID - Type Unspecified
OH5555290001Medicare NSC