MEDICARE: FAIR ACRES NURSING HOME INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1023142924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIR ACRES NURSING HOME INC

Provider Business Mailing Address
First Line	:	514 E JACKSON ST
Second Line	:
City	:	DU QUOIN
State	:	IL
Zip	:	62832-2427
Country	:	US
Telephone Number	:	618-542-4731
Fax Number	:	618-542-2651

Provider Business Practice Location Address
First Line	:	514 E JACKSON ST
Second Line	:
City	:	DU QUOIN
State	:	IL
Zip	:	62832-2427
Country	:	US
Telephone Number	:	618-542-4731
Fax Number	:	618-542-2651

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DIANA KINGTON
Credential	:
Telephone Number	:	618-549-8331

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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Directions to “FAIR ACRES NURSING HOME INC ” Practice Location

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