Organization
DECATUR HCO, LLC
Active
Other names
Decatur Rehabilitation & Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. PETERSEN (MANAGER)
(309) 689-5880
Entity
Organization
Contact information
Practice address
136 S DIPPER LN, DECATUR, IL 62522-1841
(217) 428-7767
(217) 428-7454
Mailing address
830 W TRAILCREEK DR, PEORIA, IL 61614-1862
(309) 691-8113
(309) 691-8622
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0043455
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20-3224201009
—
IL
Enumeration date
06/02/2006
Last updated
12/10/2020
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