Organization
PETERSEN MANAGEMENT COMPANY, LLC
Active
Parent organization
PETERSEN HEALTH CARE II, INC
Other names
White Oak Rehabilitation & 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
1700 WHITE ST, MOUNT VERNON, IL 62864-4349
(618) 242-4075
(618) 242-4092
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
743055934014
—
IL
Enumeration date
07/09/2006
Last updated
05/23/2013
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