Provider Demographics
NPI:1467991265
Name:CARRIER MILLS NURSING & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:CARRIER MILLS NURSING & REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-713-5284
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:CARRIER MILLS
Mailing Address - State:IL
Mailing Address - Zip Code:62917-0068
Mailing Address - Country:US
Mailing Address - Phone:618-994-2323
Mailing Address - Fax:618-994-4082
Practice Address - Street 1:6789 US 45 S
Practice Address - Street 2:
Practice Address - City:CARRIER MILLS
Practice Address - State:IL
Practice Address - Zip Code:62917-1225
Practice Address - Country:US
Practice Address - Phone:618-994-2323
Practice Address - Fax:618-994-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility