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NPI Code Detail

MEDICARE: PETERSEN HEALTH CARE - FARMER CITY, LLC

MEDICARE: PETERSEN HEALTH CARE - FARMER CITY, LLC
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 Facility000041251IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487633269
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETERSEN HEALTH CARE - FARMER CITY, LLC
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 : 309-691-1862
Provider Business Practice Location Address
First Line : 404 BROOKVIEW DR
Second Line :
City : FARMER CITY
State : IL
Zip : 61842-9746
Country : US
Telephone Number : 309-691-8113
Fax Number : 309-689-8622
Authorized Official
Title or Position : MANAGER
Name : MR. MARK PETERSEN
Credential :
Telephone Number : 309-691-8113
Provider Enumeration Date : 01/11/2006
Last Update Date : 01/28/2020

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