MEDICARE: FAIRLAWN MEDICAL INVESTORS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0091	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669435616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRLAWN MEDICAL INVESTORS, LLC

Provider Business Mailing Address
First Line	:	3001 KEITH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3713
Country	:	US
Telephone Number	:	423-473-5751
Fax Number	:	423-339-8342

Provider Business Practice Location Address
First Line	:	370 WEST ST
Second Line	:
City	:	LEOMINSTER
State	:	MA
Zip	:	01453-2073
Country	:	US
Telephone Number	:	978-343-4411
Fax Number	:	978-343-6464

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	CINDY S CROSS
Credential	:
Telephone Number	:	423-473-5867

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	02/12/2008

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