Organization
ASPEN HCO, LLC
Active
Other names
Aspen Rehab & Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PETERSEN (MANAGER)
(309) 691-8113
Entity
Organization
Contact information
Practice address
1403 9TH AVE, SILVIS, IL 61282-1757
(309) 796-2600
(309) 796-2981
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
0043737
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203224201002
—
IL
Enumeration date
10/07/2005
Last updated
12/17/2020
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