Organization
KEWANEE HCO, LLC
Active
Other names
Kewanee Care Home
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. PETERSEN (MANAGER)
(309) 689-5880
Entity
Organization
Contact information
Practice address
144 JUNIOR AVE, KEWANEE, IL 61443-2554
(309) 853-4429
(309) 853-9209
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
0026518
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37-1068286001
—
IL
Enumeration date
04/21/2006
Last updated
09/14/2020
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