Provider Demographics
NPI:1386943306
Name:THREE SPRINGS LODGE NURSING HOME LLC
Entity type:Organization
Organization Name:THREE SPRINGS LODGE NURSING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-826-3210
Mailing Address - Street 1:161 THREE SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1064
Mailing Address - Country:US
Mailing Address - Phone:618-826-3210
Mailing Address - Fax:618-826-3821
Practice Address - Street 1:161 THREE SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1064
Practice Address - Country:US
Practice Address - Phone:618-826-3210
Practice Address - Fax:618-826-3821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility