Provider Demographics
NPI:1851390181
Name:FAIR ACRES NURSING HOME INC
Entity Type:Organization
Organization Name:FAIR ACRES NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-549-8331
Mailing Address - Street 1:514 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-2427
Mailing Address - Country:US
Mailing Address - Phone:618-542-4731
Mailing Address - Fax:618-542-2651
Practice Address - Street 1:514 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-2427
Practice Address - Country:US
Practice Address - Phone:618-542-4731
Practice Address - Fax:618-542-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========801Medicaid
IL=========001Medicaid
IL145008Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER