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NPI Code Detail

MEDICARE: PETERSEN HEALTH CARE, INC

MEDICARE: PETERSEN HEALTH CARE, INC
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 Facility0046060IL

General Provider Information

NPI Number : 1609027846
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETERSEN HEALTH CARE, INC
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 :
Provider Business Practice Location Address
First Line : 100 EASTVIEW PL
Second Line :
City : SULLIVAN
State : IL
Zip : 61951-1674
Country : US
Telephone Number : 217-728-7367
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MARK PETERSEN
Credential :
Telephone Number : 309-691-8113
Provider Enumeration Date : 10/07/2008
Last Update Date : 10/07/2008

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Directions to “PETERSEN HEALTH CARE, INC ” Practice Location

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