Organization
PRAIRIE CITY HCO, LLC
Active
Other names
Prairie City Rehab & Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. PETERSEN (MANAGER)
(309) 689-5880
Entity
Organization
Contact information
Practice address
825 E MAIN ST, PRAIRIE CITY, IL 61470-9411
(309) 775-3313
(309) 775-3311
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
0045377
IL
314000000X
Skilled Nursing Facility
Primary
146038
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0045377
—
IL
Enumeration date
08/23/2006
Last updated
09/15/2020
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