Healthcare Provider Details

I. General information

NPI: 1881386670
Provider Name (Legal Business Name): THREE SPRINGS SENIOR LIVING & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 08/10/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 3 SPRINGS RD
CHESTER IL
62233-1064
US

IV. Provider business mailing address

215 E LOCUST ST
HARRISBURG IL
62946-1504
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-3210
  • Fax: 618-826-3821
Mailing address:
  • Phone: 618-713-5284
  • Fax: 618-294-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT E STOUT
Title or Position: CEO/OWNER
Credential: LNHA
Phone: 618-713-5284