Healthcare Provider Details

I. General information

NPI: 1942296454
Provider Name (Legal Business Name): FAIRFIELD NURSING & REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 BERMUDA DR
SAINT LOUIS MO
63121-1407
US

IV. Provider business mailing address

5303 BERMUDA DR
SAINT LOUIS MO
63121-1407
US

V. Phone/Fax

Practice location:
  • Phone: 314-385-0910
  • Fax: 314-385-7179
Mailing address:
  • Phone: 314-385-0910
  • Fax: 314-385-7179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030829
License Number StateMO

VIII. Authorized Official

Name: MR. JAMES C LINCOLN
Title or Position: SHAREHOLDER
Credential:
Phone: 573-746-7100