Organization
LEBANON HCO, LLC
Active
Other names
Lebanon Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. PETERSEN (MANAGER)
(309) 689-5880
Entity
Organization
Contact information
Practice address
1201 N ALTON ST, LEBANON, IL 62254-1103
(618) 537-4401
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
0016964
IL
Other
Enumeration date
12/29/2005
Last updated
09/11/2020
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