Provider Demographics
NPI:1154649556
Name:FAIRFIELD PAVILION
Entity Type:Organization
Organization Name:FAIRFIELD PAVILION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. MARKETING
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-699-4651
Mailing Address - Street 1:5251 DIXIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-699-4600
Mailing Address - Fax:513-699-3045
Practice Address - Street 1:5251 DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-699-4600
Practice Address - Fax:513-699-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2366A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility