Provider Demographics
NPI:1144392523
Name:FAIRMOUNT NURSING HOME INC
Entity Type:Organization
Organization Name:FAIRMOUNT NURSING HOME INC
Other - Org Name:HOLLY HILL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:OHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-338-8220
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:10190 FAIRMOUNT ROAD
Mailing Address - City:NEWBURY
Mailing Address - State:OH
Mailing Address - Zip Code:44065-0337
Mailing Address - Country:US
Mailing Address - Phone:440-338-8220
Mailing Address - Fax:440-564-5721
Practice Address - Street 1:10190 FAIRMOUNT ROAD
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:OH
Practice Address - Zip Code:44065-0337
Practice Address - Country:US
Practice Address - Phone:440-338-8220
Practice Address - Fax:440-564-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4192251G00000X, 310400000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251G00000XAgenciesHospice Care, Community Based
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0034359Medicaid
OH0034359Medicaid