Provider Demographics
NPI:1871693846
Name:WHITEHALL LEASING CORP
Entity type:Organization
Organization Name:WHITEHALL LEASING CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-831-6800
Mailing Address - Street 1:5198 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1331
Mailing Address - Country:US
Mailing Address - Phone:216-831-6800
Mailing Address - Fax:216-831-9734
Practice Address - Street 1:4805 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-6125
Practice Address - Country:US
Practice Address - Phone:614-501-8271
Practice Address - Fax:614-861-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5798314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2180152Medicaid
OH366201Medicare ID - Type Unspecified
OH4554540001Medicare NSC