Provider Demographics
NPI:1952460958
Name:EARLEY AND ROSS, LTD.
Entity Type:Organization
Organization Name:EARLEY AND ROSS, LTD.
Other - Org Name:AUTUMN YEARS NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-584-2497
Mailing Address - Street 1:580 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SABINA
Mailing Address - State:OH
Mailing Address - Zip Code:45169-1253
Mailing Address - Country:US
Mailing Address - Phone:937-584-2497
Mailing Address - Fax:937-584-2508
Practice Address - Street 1:580 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SABINA
Practice Address - State:OH
Practice Address - Zip Code:45169-1253
Practice Address - Country:US
Practice Address - Phone:937-584-2497
Practice Address - Fax:937-584-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3728314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2218291Medicaid
OH366091Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER