Organization
PETERSEN HEALTH CARE, INC.
Active
Other names
Meadowlawn Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MARK B. PETERSEN (PRESIDENT)
(309) 691-8113
Entity
Organization
Contact information
Practice address
4656 W KIMBERLY RD, DAVENPORT, IA 52806-7111
(563) 391-5150
(563) 391-3901
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
820624
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0809459
—
IA
Enumeration date
04/21/2006
Last updated
08/22/2020
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