Fairfield Senior Living & Rehabilitation LLC
Organization Active NPI Skilled Nursing Facility · Fairfield, IL
NPI 1639907264 · NPPES record last updated Jul 24, 2024
Key facts
- NPI
- 1639907264
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- FAIRFIELD SENIOR LIVING & REHABILITATION LLC
- Practice address
- 305 NW 11TH St
Fairfield, IL 62837-1203 - Phone
- (618) 842-3036
- NPI assigned
- Jul 24, 2024
- Organization subpart
- No
Authorized official
- Name
- Scott Stout
- Title
- Ceo
- Phone
- (618) 294-8696
Owners & managing parties with NPI records 1
-
John A Flick, D.O.
Facilities with the same owner 4
Practitioners 1
-
John A Flick, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Fairfield Senior Living & Rehabilitation LLC
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 1, 2000
- Medicare certification status
- Active
- Certified beds
- 104 · 49.8 residents per day on average
- Chain
- WLC Management Firm
- Penalties (3 years)
- 10 · fines totaling $126,045
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Skilled nursing facility certification: CCN 146000
- Legal name
- FAIRFIELD SENIOR LIVING & REHABILITATION LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 1, 2000
- Last certification
- May 28, 2024
- Beds
- 104
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- WLC Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 305 NW 11TH St
Fairfield, IL 62837-1203 - Nursing home name
- FAIRFIELD SENIOR LIVING & REHABILITATION LLC
- Affiliated entity
- WLC MANAGEMENT FIRM
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Scott E Stout |
5% Or Greater Direct Ownership Interest |
Nov 1, 2024 | 100% |
| Corporate Officer |
Nov 1, 2024 | 100% | |
| Operational/Managerial Control | Oct 25, 2024 | ||
| Jeananne Donelson |
Operational/Managerial Control | Nov 1, 2024 | |
| WLC Management Firm LLC |
Operational/Managerial Control | Oct 24, 2024 | |
| Adp of the SNF | Jan 10, 2025 | ||
| Lon Lindner |
Corporate Officer |
Nov 1, 2024 | 100% |
| Operational/Managerial Control | Dec 9, 2024 | ||
| Adp of the SNF | Jan 10, 2025 | ||
| Michelle Tweedy |
Operational/Managerial Control | Dec 9, 2024 | |
| Adp of the SNF | Jan 10, 2025 | ||
| Mark Taulbee |
Operational/Managerial Control | Nov 25, 2024 | |
| Adp of the SNF | Jan 10, 2025 | ||
| John a Flick |
Operational/Managerial Control | Nov 1, 2024 | |
| Adp of the SNF | Jan 10, 2025 | ||
| Alice Broster |
Operational/Managerial Control | Dec 9, 2024 | |
| Adp of the SNF | Jan 10, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250110000224 | IL | Part a Provider - Skilled Nursing Facility | 8022546639 | Practice locations: Fairfield, IL |
National Provider Directory
Interoperability endpoints
- sstout@wlcfirm.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
305 NW 11TH St
Fairfield, IL 62837-1203
Mailing address
35 S Vine St
Harrisburg, IL 62946-1738
Phone (618) 294-8696
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | SStout@wlcfirm.com | Direct |
Other providers in Fairfield, IL
- Fairfield Memorial Hospital Association
- Fairfield Memorial Hospital Association
- Fairfield Memorial Hospital Association
- Fairfield Memorial Hospital Association
- Fairfield School District 12
- Erica T Fearday
- Melissa Felowitz
- Leyth Fenton
- Ryan Douglas Ferguson
- Emma Funk
All providers in Fairfield, IL · Skilled Nursing Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.