Provider Demographics
NPI:1376731075
Name:EARLEY & ROSS OF FAYETTE COUNTY LL,LLC
Entity Type:Organization
Organization Name:EARLEY & ROSS OF FAYETTE COUNTY LL,LLC
Other - Org Name:HILLCREST MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-335-5794
Mailing Address - Street 1:6674 STAFFORD RD SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-9770
Mailing Address - Country:US
Mailing Address - Phone:740-335-5794
Mailing Address - Fax:740-335-8183
Practice Address - Street 1:6674 STAFFORD RD SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-9770
Practice Address - Country:US
Practice Address - Phone:740-335-5794
Practice Address - Fax:740-335-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility