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General NPI Number Information
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NPI Number | 1790819589
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Entity Type | Organization
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Legal Business Name | THREE SPRINGS LODGE NURSING HOME INC
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 161THREE SPRINGS ROAD
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City | CHESTER
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State | IL
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Zip | 62233-1064
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Country | US
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Telephone | 618-826-3210
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Fax | 618-826-3821
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Provider Business Mailing Address
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Address Line | 161THREE SPRINGS ROAD
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City | CHESTER
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State | IL
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Zip | 62233-1064
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Country | US
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Telephone | 618-826-3210
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Fax | 618-826-3821
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Authorized Official
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Title or Position | CONTROLLER
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Name | ROGER W BAGLEY
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Credential |
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Telephone | 618-549-8331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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