Healthcare Provider Details

I. General information

NPI: 1144392523
Provider Name (Legal Business Name): FAIRMOUNT NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10190 FAIRMOUNT ROAD
NEWBURY OH
44065-0337
US

IV. Provider business mailing address

PO BOX 337 10190 FAIRMOUNT ROAD
NEWBURY OH
44065-0337
US

V. Phone/Fax

Practice location:
  • Phone: 440-338-8220
  • Fax: 440-564-5721
Mailing address:
  • Phone: 440-338-8220
  • Fax: 440-564-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number4192
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number4192
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number4192
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4192
License Number StateOH

VIII. Authorized Official

Name: MR. GEORGE H OHMAN
Title or Position: PRESIDENT
Credential:
Phone: 440-338-8220