Organization · Type 2 NPI

Decatur Hco, LLC

Nursing Facility/Intermediate Care Facility · Decatur, IL

NPI number 1063459329 Active

Practice location

136 S Dipper Ln
Decatur, IL 62522-1841

Call (217) 428-7767 Map

Fax (217) 428-7454

Mailing address

830 W Trailcreek Dr
Peoria, IL 61614-1862

Specialties and licenses

Taxonomy	Code	License
Nursing Facility/Intermediate Care Facility Primary	313M00000X	0043455 (IL)

Nursing Facility/Intermediate Care Facility: An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical conditi…

5 other providers at this address

NPI record

NPI: 1063459329
Entity type: Organization (Type 2)
Issued: Jun 2, 2006
Last updated: Dec 10, 2020
Status: Active

Other names

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Decatur Rehabilitation & Health Care Center · doing business as
Decatur Rehabilitation & Health Care Center · doing business as

Authorized official

Mark B. Petersen
Manager
(309) 689-5880

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1063459329

Decatur Hco, LLC's National Provider Identifier is 1063459329, issued on Jun 2, 2006. The primary taxonomy on file is Nursing Facility/Intermediate Care Facility (313M00000X), and the practice location is in Decatur, IL. The record was last updated on Dec 10, 2020.