Petersen Health Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0047589 Issued in IL

Legal business name

PETERSEN HEALTH OPERATIONS, LLC

Doing business as

Vandalia Rehab & Health Care Center

Practice address

1500 W Saint Louis Ave
Vandalia, IL 62471-2535

Phone

(618) 283-4262

NPI assigned

Nov 5, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Petersen

Title

Manager

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Vandalia Rehab & Health Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1083868095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 W TRAILCREEK DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141862",
            "telephone_number": "309-691-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W SAINT LOUIS AVE",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624712535",
            "telephone_number": "618-283-4262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "309-691-8113"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0047589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203224201024",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vandalia Rehab & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bethany Oberlink, PHARMD
• Tina Sue Otto, LPC, CADC
• Pain Relief Center of Vandalia Inc
• Penny Attaway
• Kimberly Diane Peppler, CCC-SLP
• William Phillips
• Tamela Stacy Polanin, LCPC
• Kasey A Rankin
• Rita Armbrust
• Cecelia Ritter

• Skilled Nursing Facility in Vandalia, IL
• Providers in Vandalia, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.