Organization
MCLEANSBORO HCO, LLC
Active
Other names
McLeansboro Rehabilitation & Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. PETERSEN (MANAGER)
(309) 689-5880
Entity
Organization
Contact information
Practice address
405 W CARPENTER ST, MC LEANSBORO, IL 62859-1012
(618) 643-3728
(618) 643-2330
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
0047498
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20-3224201014
—
IL
Enumeration date
06/04/2006
Last updated
09/15/2020
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