Organization · Type 2 NPI

Petersen Management Company, LLC

Nursing Facility/Intermediate Care Facility · Mount Vernon, IL

NPI number 1780767897 Active

Practice location

5 Doctors Park Rd
Mount Vernon, IL 62864-6224

Call (618) 242-1064 Map

Fax (618) 242-7559

Mailing address

830 W Trailcreek Dr
Peoria, IL 61614-1862

Specialties and licenses

Taxonomy	Code	License
Nursing Facility/Intermediate Care Facility Primary	313M00000X	0039800 (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…

4 other providers at this address

Other nursing facility/intermediate care facility providers in Mount Vernon

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NPI record

NPI: 1780767897
Entity type: Organization (Type 2)
Issued: Oct 23, 2006
Last updated: May 30, 2013
Status: Active
Subpart: Yes of Petersen Health Care Ii, Inc.

Other names

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Mt. Vernon Health Care Center · doing business as

Authorized official

Mark B. Petersen
President
(309) 691-8113

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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 1780767897

Petersen Management Company, LLC's National Provider Identifier is 1780767897, issued on Oct 23, 2006. The primary taxonomy on file is Nursing Facility/Intermediate Care Facility (313M00000X), and the practice location is in Mount Vernon, IL. The record was last updated on May 30, 2013.