Organization
PETERSEN HEALTH PROPERTIES, LLC
Active
Other names
Coutryview Care Center of Macomb
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. PETERSEN (MANAGER)
(309) 691-8113
Entity
Organization
Contact information
Practice address
400 W GRANT ST, MACOMB, IL 61455-2867
(309) 837-2386
(309) 836-9191
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
0047431
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20-3224201015
—
IL
Enumeration date
06/04/2006
Last updated
12/31/2019
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