Organization
HAVANA HCO, LLC
Active
Parent organization
PETERSEN HEALTH CARE, INC.
Other names
Havana Health Care Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PETERSEN HEALTH CARE, INC.
Authorized official
MARK B. PETERSEN (MANAGER)
(309) 689-5880
Entity
Organization
Contact information
Practice address
609 N HARPHAM ST, HAVANA, IL 62644
(309) 543-6121
(309) 543-1233
Mailing address
830 W TRAILCREEK DR, PEORIA, IL 61614-1862
(309) 691-8113
(309) 691-8622
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0046086
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37-1068286007
—
IL
Enumeration date
04/26/2006
Last updated
09/28/2020
About Stedi
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