MEDICARE: SALINE CARE CENTER, LLC

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	313M00000X	Nursing Facility/Intermediate Care Facility	0029462	IL
2	314000000X	Skilled Nursing Facility	0029462	IL

General Provider Information

NPI Number	:	1285620096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALINE CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	120 S LAND ST
Second Line	:	P.O. BOX 468
City	:	HARRISBURG
State	:	IL
Zip	:	62946-1849
Country	:	US
Telephone Number	:	618-252-7405
Fax Number	:	618-253-3418

Provider Business Practice Location Address
First Line	:	120 S LAND ST
Second Line	:
City	:	HARRISBURG
State	:	IL
Zip	:	62946-1849
Country	:	US
Telephone Number	:	618-252-7405
Fax Number	:	618-253-3418

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. SCOTT STOUT
Credential	:	LNHA
Telephone Number	:	618-252-7405

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	02/14/2017

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