MEDICARE: FAIRVIEW REHABILITATION & HEALTHCARE 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

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	:	1730748575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW REHABILITATION & HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	215 E LOCUST ST
Second Line	:
City	:	HARRISBURG
State	:	IL
Zip	:	62946-1504
Country	:	US
Telephone Number	:	618-294-8696
Fax Number	:	618-294-8699

Provider Business Practice Location Address
First Line	:	602 E JACKSON ST
Second Line	:
City	:	DU QUOIN
State	:	IL
Zip	:	62832-2429
Country	:	US
Telephone Number	:	618-542-3441
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SCOTT E STOUT
Credential	:	LNHA
Telephone Number	:	618-294-8696

Provider Enumeration Date	:	06/06/2019
Last Update Date	:	06/06/2019

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Directions to “FAIRVIEW REHABILITATION & HEALTHCARE LLC ” Practice Location

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