Stonebridge Senior Living Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0051888 Issued in IL

Legal business name

STONEBRIDGE SENIOR LIVING CENTER, LLC

Practice address

902 S McLeansboro St
Benton, IL 62812-3413

Phone

(618) 439-4501

Fax

(618) 435-3141

NPI assigned

Mar 1, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Scott E. Stout

Title

Manager

Phone

(618) 713-5284

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487030400000",
    "number": "1427186451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 S MCLEANSBORO ST",
            "address_2": "PO BOX 968",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628123413",
            "telephone_number": "618-439-4501",
            "fax_number": "618-435-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 S MCLEANSBORO ST",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628123413",
            "telephone_number": "618-439-4501",
            "fax_number": "618-435-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEBRIDGE SENIOR LIVING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2017-02-14",
        "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": "IL",
            "license": "0051888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Keith Spencer, O.D.
• Michael Sebastian Spencer, O.D.
• Chelsea Steele
• Hannah Stock
• Stonebridge Nursing & Rehabilitation Center, LLC
• Mariah Stubblefield, MSOTR/L
• David Frank Szoke, M.D.
• Olufeyisayo Jokotola Taiwo, M.D.
• Landon Tate
• Teel Chiropractic Clinic, LTD.

• Skilled Nursing Facility in Benton, IL
• Providers in Benton, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.