Organization
PETERSEN MANAGEMENT COMPANY, LLC
Active
Parent organization
PETERSEN HEALTH CARE II, INC.
Other names
Palm Terrace of Mattoon
Organization subpart
Yes
Provider details
NPI number
Legal business name
PETERSEN HEALTH CARE II, INC.
Authorized official
MARK B. PETERSEN (PRESIDENT)
(309) 691-8113
Entity
Organization
Contact information
Practice address
1000 PALM AVE, MATTOON, IL 61938-6031
(217) 234-7403
(217) 258-6642
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
0046037
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74-3055934001
—
IL
Enumeration date
04/21/2006
Last updated
05/23/2013
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