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Petersen Management Company, Llc
Nursing Facility/Intermediate Care Facility in Mount Vernon, Illinois
NPI 1780767897

Petersen Management Company, Llc is a Nursing Facility/Intermediate Care Facility based in Peoria, IL. Petersen Management Company, Llc practices in Mount Vernon, IL. The NPI Number for Petersen Management Company, Llc is 1780767897 and holds a License No. 0039800 (Illinois).

The current practice location address for Petersen Management Company, Llc is 5 Doctors Park Rd, Mount Vernon, IL and can be reached out via phone at 618-242-1064 and via fax at 618-242-7559. You can also correspond with Petersen Management Company, Llc through the mailing address at 830 W TRAILCREEK DR, PEORIA, IL - 61614-1862 (mailing address contact number: 309-691-8113).

Location: 5 Doctors Park Rd, Mount Vernon, IL, 61614-1862
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1780767897
Provider Name
Petersen Management Company, Llc
Credential
Provider Entity Type
Organization
Address
5 Doctors Park Rd, Mount Vernon, IL, 61614-1862
Phone Number
618-242-1064
Fax Number
618-242-7559
Provider Enumeration Date
10/23/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
391516877001 05 IL
institution
Provider Business Practice Location Address Details
Address
5 Doctors Park Rd
City
Mount Vernon
State
Illinois
Zip
62864-6224
Phone Number
618-242-1064
Fax Number
618-242-7559
person
Provider Business Mailing Address Details
Address
830 W Trailcreek Dr
City
Peoria
State
Illinois
Zip
61614-1862
Phone Number
309-691-8113
Fax Number
309-691-8622
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Nursing Facility/Intermediate Care Facility
Speciality
-
Taxonomy
313M00000X
License No.
0039800 (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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