Provider Demographics
NPI:1659747368
Name:FILLYAW HILL ADULT FAMILY HOME
Entity Type:Organization
Organization Name:FILLYAW HILL ADULT FAMILY HOME
Other - Org Name:TERRY L. FILLYAW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FILLYAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-647-7391
Mailing Address - Street 1:589 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-1904
Mailing Address - Country:US
Mailing Address - Phone:608-647-7391
Mailing Address - Fax:608-647-7391
Practice Address - Street 1:637 E 3RD ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-1539
Practice Address - Country:US
Practice Address - Phone:608-383-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FILLYAW ADULT FAMILY HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency