Organization
PETERSEN HEALTH CARE - NOKOMIS, LLC
Active
Other names
Nokomis Rehabilitation & Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PETERSEN (MANAGER)
(309) 691-8113
Entity
Organization
Contact information
Practice address
505 STEVENS ST, NOKOMIS, IL 62075-1442
(217) 563-7725
Mailing address
830 W TRAILCREEK DR, PEORIA, IL 61614-1862
(309) 691-8113
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0049114
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260372393003
—
IL
Enumeration date
11/05/2008
Last updated
11/05/2008
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