Provider Demographics
NPI:1982695508
Name:WYANT LEASING CO., LLC
Entity Type:Organization
Organization Name:WYANT LEASING CO., LLC
Other - Org Name:WYANT WOODS CARE 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 200
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:513-489-7100
Mailing Address - Fax:513-530-1359
Practice Address - Street 1:200 WYANT RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-4228
Practice Address - Country:US
Practice Address - Phone:330-836-7953
Practice Address - Fax:330-836-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5612314000000X
OH1428N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2607174Medicaid
OH5621050001Medicare NSC
OH2607174Medicaid