Organization
PETERSEN HEALTH CARE - ILLINI, LLC
Active
Other names
Illini Heritage Rehab & Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. PETERSEN (PRESIDENT)
(309) 691-8113
Entity
Organization
Contact information
Practice address
1315 CURT DRIVE, CHAMPAIGN, IL 61820
(217) 352-5707
(217) 352-2607
Mailing address
830 W. TRAILCREEK DRIVE, PEORIA, IL 61614
(309) 691-8113
(309) 691-8622
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0042440
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300318970007
—
IL
Enumeration date
08/22/2006
Last updated
02/14/2024
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