Healthcare Provider Details

I. General information

NPI: 1851390181
Provider Name (Legal Business Name): FAIR ACRES NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 E JACKSON ST
DU QUOIN IL
62832-2427
US

IV. Provider business mailing address

514 E JACKSON ST
DU QUOIN IL
62832-2427
US

V. Phone/Fax

Practice location:
  • Phone: 618-542-4731
  • Fax: 618-542-2651
Mailing address:
  • Phone: 618-542-4731
  • Fax: 618-542-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANA S KINGTON
Title or Position: PRESIDENT
Credential:
Phone: 618-549-8331