NPIMap

Organization Active NPI

Stonebridge Nursing & Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Benton, IL
National Provider Identifier
1609315407
Registry record updated Feb 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
STONEBRIDGE NURSING & REHABILITATION CENTER, LLC
Practice address
902 S McLeansboro St
Benton, IL 62812-3413
Phone
(618) 439-4501
Fax
(618) 435-3141
NPI assigned
Feb 14, 2017
Last updated
Feb 14, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2017

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

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

902 S McLeansboro St
Benton, IL 62812-3413

Mailing address

PO Box 968
Benton, IL 62812-0968
Phone (618) 439-4501

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170327000556 IL Part A Provider - Skilled Nursing Facility 3870878218 Practice locations: Benton, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609315407. Details of each certification follow.

Skilled nursing facility certification: CCN 146144

Legal name
STONEBRIDGE NURSING & REHABILITATION CENTER, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Mar 25, 2011
Last certification
Dec 19, 2024
Beds
80
Ownership / control type
Corporation
Organization structure
LLCProprietary
Incorporated
Jan 26, 2017 in IL
Enrollment address
902 S McLeansboro St
Benton, IL 62812-3413
Nursing home name
STONEBRIDGE NURSING & REHAB
Affiliated entity
WLC MANAGEMENT FIRM

Care Compare: Nursing home

Medicare Care Compare
Listed as
Stonebridge Nursing & RehabCCN 146144 · All quality measures
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Mar 25, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8053.2 residents per day on average
Chain
WLC Management Firm18 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
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%
Kelsie Pedigo Individual W-2 Managing EmployeeAd; Oct 11, 2021 75%
Shannon B Rider Individual Contracted Managing EmployeeMD; Jan 1, 2024
WLC Management Firm LLC Organization, Harrisburg, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2017 100%

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.

Practitioners & affiliated clinicians

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1487030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487030400000",
    "number": "1609315407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 968",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628120968",
            "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 NURSING & REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-14",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, IL

Sources for this page

Verify at the official NPI Registry.