Organization
PETERSEN MANAGEMENT COMPANY, LLC
Active
Parent organization
PETERSEN HEALTH CARE II, INC.
Other names
Mt. Vernon Health Care Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PETERSEN HEALTH CARE II, INC.
Authorized official
MARK B. PETERSEN (PRESIDENT)
(309) 691-8113
Entity
Organization
Contact information
Practice address
5 DOCTORS PARK RD, MOUNT VERNON, IL 62864-6224
(618) 242-1064
(618) 242-7559
Mailing address
830 W TRAILCREEK DR, PEORIA, IL 61614-1862
(309) 691-8113
(309) 691-8622
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0039800
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
391516877001
—
IL
Enumeration date
10/23/2006
Last updated
05/30/2013
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