MEDICARE: JAMESTOWN MANOR 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	313M00000X	Nursing Facility/Intermediate Care Facility
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1629077953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMESTOWN MANOR INC

Provider Business Mailing Address
First Line	:	602 E JACKSON ST
Second Line	:
City	:	DU QUOIN
State	:	IL
Zip	:	62832-2429
Country	:	US
Telephone Number	:	618-542-3441
Fax Number	:	618-542-6351

Provider Business Practice Location Address
First Line	:	602 E JACKSON ST
Second Line	:
City	:	DU QUOIN
State	:	IL
Zip	:	62832-2429
Country	:	US
Telephone Number	:	618-542-3441
Fax Number	:	618-542-6351

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/11/2025

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Directions to “JAMESTOWN MANOR INC ” Practice Location

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