Organization
PETERSEN HEALTH PROPERTIES, LLC
Active
Other names
South Elgin Rehabilitation & Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. PETERSEN (MANAGER)
(309) 691-8113
Entity
Organization
Contact information
Practice address
746 W SPRING ST, SOUTH ELGIN, IL 60177-1424
(847) 697-0565
(847) 697-0568
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
0047621
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213224201010
—
IL
Enumeration date
07/09/2006
Last updated
12/31/2019
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