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Phillip A. Immesoete Md, Ltd
Nursing Facility/Intermediate Care Facility in Peoria, Illinois
NPI 1245544543

Phillip A. Immesoete Md, Ltd is a Nursing Facility/Intermediate Care Facility based in Peoria, IL. Phillip A. Immesoete Md, Ltd practices in Peoria, IL. The NPI Number for Phillip A. Immesoete Md, Ltd is 1245544543 and holds a License No. 036042568 (Illinois).

The current practice location address for Phillip A. Immesoete Md, Ltd is 5401 N Knoxville Ave, Peoria, IL and can be reached out via phone at 309-691-0030 and via fax at 309-691-9262.

Location: 5401 N Knoxville Ave, Peoria, IL, 61614-5098
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1245544543
Provider Name
Phillip A. Immesoete Md, Ltd
Credential
Provider Entity Type
Organization
Address
5401 N Knoxville Ave, Peoria, IL, 61614-5098
Phone Number
309-691-0030
Fax Number
309-691-9262
Provider Enumeration Date
07/29/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
036042568 05 IL
institution
Provider Business Practice Location Address Details
Address
5401 N Knoxville Ave
City
Peoria
State
Illinois
Zip
61614-5098
Phone Number
309-691-0030
Fax Number
309-691-9262
person
Provider Business Mailing Address Details
Address
5401 N Knoxville Ave
City
Peoria
State
Illinois
Zip
61614-5098
Phone Number
309-691-0030
Fax Number
309-691-9262
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Nursing Facility/Intermediate Care Facility
Speciality
-
Taxonomy
313M00000X
License No.
036042568 (Illinois)
Definition
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 condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
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