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Organization
PETERSEN HEALTH QUALITY, LLC
Active
Organization
PETERSEN HEALTH QUALITY, LLC
Active
Parent organization
PETERSEN HEALTH CARE, INC
Other names
Countryview Terrace
Organization subpart
Yes
Provider details
NPI number
Legal business name
PETERSEN HEALTH CARE, INC
Authorized official
MARK B. PETERSEN (PRESIDENT)
(309) 691-8113
Entity
Organization
Contact information
Practice address
52 OLD RTE 45, LOUISVILLE, IL 62858-0116
(618) 686-4542
(618) 686-2179
Mailing address
830 W TRAILCREEK DR, PEORIA, IL 61614-1862
(309) 691-8113
(309) 691-8622
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0046078
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37-1068286008
—
IL
Enumeration date
04/21/2006
Last updated
02/14/2024
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