NPIMap

Organization Active NPI

Pinckneyville Nursing & Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Pinckneyville, IL
National Provider Identifier
1013456490
Registry record updated Feb 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PINCKNEYVILLE NURSING & REHABILITATION CENTER, LLC
Practice address
708 Virginia CT
Pinckneyville, IL 62274-1538
Phone
(618) 357-2493
Fax
(618) 357-3120
NPI assigned
Feb 17, 2017
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Scott E. Stout
Title
Manager
Phone
(618) 713-5284

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 12

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pinckneyville Nursing & RehabCCN 146175
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 27, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6038.4 residents per day on average
Chain
WLC Management Firm18 facilities in the chain
Penalties (3 years)
2Fines totaling $100,864

Processed by Care Compare on Aug 1, 2026.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Skilled nursing facility certification: CCN 146175

Medicare enrollment files
Legal name
PINCKNEYVILLE NURSING & REHABILITATION CENTER LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Feb 27, 2015
Last certification
Apr 10, 2025
Beds
60
Ownership / control type
Limited Liability Corporation
Multi-facility organization
WLC Mgmnt Firm
Most recent change of ownership
Mar 1, 2017
Organization structure
LLCProprietary
Incorporated
Jan 26, 2017 in IL
Enrollment address
708 Virginia CT
Pinckneyville, IL 62274-1538
Nursing home name
PINCKNEYVILLE NURSING & REHAB
Affiliated entity
WLC MANAGEMENT FIRM

All disclosed owners & managing parties 4

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Robert J Davidson Individual Contracted Managing EmployeeAd; Feb 1, 2017
Scott E Stout Individual 5% Or Greater Indirect Ownership InterestCeo Mar 1, 2017 100%
Corporate OfficerCeo Mar 1, 2017 100%
Operational/Managerial ControlCeo Mar 1, 2017 100%
Nicole Graff Individual W-2 Managing EmployeeAd; Oct 9, 2023 75%
WLC Management Firm LLC Organization, Harrisburg, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2017 100%

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20170321000517 IL Part a Provider - Skilled Nursing Facility 1052696762 Practice locations: Pinckneyville, IL

National Provider Directory

National Provider Directory

Locations

35 S Vine St
Harrisburg, IL 62946
Phone (618) 713-5284

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

NPPES NPI Registry

Primary practice location

708 Virginia CT
Pinckneyville, IL 62274-1538

Mailing address

708 Virginia CT
Pinckneyville, IL 62274-1538
Phone (618) 357-2493

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 17, 2017.

{
    "created_epoch": "1487289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487289600000",
    "number": "1013456490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 VIRGINIA CT",
            "city": "PINCKNEYVILLE",
            "state": "IL",
            "postal_code": "622741538",
            "telephone_number": "618-357-2493",
            "fax_number": "618-357-3120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 VIRGINIA CT",
            "city": "PINCKNEYVILLE",
            "state": "IL",
            "postal_code": "622741538",
            "telephone_number": "618-357-2493",
            "fax_number": "618-357-3120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINCKNEYVILLE NURSING & REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-17",
        "last_updated": "2017-02-17",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "618-713-5284",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinckneyville, IL

Sources for this page

Verify at the official NPI Registry.