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NPI Code Detail

MEDICARE: PETERSEN HEALTH CARE - FARMER CITY

MEDICARE: PETERSEN HEALTH CARE - FARMER CITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1184882490
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETERSEN HEALTH CARE - FARMER CITY
Provider Business Mailing Address
First Line : 830 W TRAILCREEK DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-1862
Country : US
Telephone Number : 309-691-8113
Fax Number : 309-691-8622
Provider Business Practice Location Address
First Line : 404 BROOKVIEW DR
Second Line :
City : FARMER CITY
State : IL
Zip : 61842-9746
Country : US
Telephone Number : 309-928-2118
Fax Number : 309-928-2313
Authorized Official
Title or Position : PRESIDENT
Name : MR. MARK B PETERSEN
Credential :
Telephone Number : 309-691-8113
Provider Enumeration Date : 05/23/2008
Last Update Date : 10/25/2008

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Directions to “PETERSEN HEALTH CARE - FARMER CITY ” Practice Location

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