Healthcare Provider Details

I. General information

NPI: 1730748575
Provider Name (Legal Business Name): FAIRVIEW REHABILITATION & HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 E JACKSON ST
DU QUOIN IL
62832-2429
US

IV. Provider business mailing address

215 E LOCUST ST
HARRISBURG IL
62946-1504
US

V. Phone/Fax

Practice location:
  • Phone: 618-542-3441
  • Fax:
Mailing address:
  • Phone: 618-294-8696
  • 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: MR. SCOTT E STOUT
Title or Position: CEO
Credential: LNHA
Phone: 618-294-8696