Provider Demographics
NPI:1861689465
Name:EARLEY & ROSS OF FAYETTE COUNTY L,LLC
Entity Type:Organization
Organization Name:EARLEY & ROSS OF FAYETTE COUNTY L,LLC
Other - Org Name:WINTERSONG VILLAGE
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:740-335-1380
Mailing Address - Street 1:719 RAWLINGS ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1517
Mailing Address - Country:US
Mailing Address - Phone:740-335-1380
Mailing Address - Fax:740-636-0643
Practice Address - Street 1:719 RAWLINGS ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1517
Practice Address - Country:US
Practice Address - Phone:740-335-1380
Practice Address - Fax:740-636-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2768189Medicaid
OH1861689465OtherFACILITY NPI
OH366262OtherMEDICARE PROVIDER NUMBER
OH1861689465OtherFACILITY NPI