Active NPI
Petersen Health Junction, LLC
- Skilled Nursing Facility
- Canton, IL
National Provider Identifier
1104882919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 0046094
- Legal business name
- PETERSEN HEALTH JUNCTION, LLC
- Practice address
- 129 S 1St Ave
Canton, IL 61520-2612 - Phone
- (309) 647-4327
- Fax
- (309) 647-4354
- NPI assigned
- Apr 21, 2006
- Organization subpart
- Yes
- Parent organization
- PETERSEN HEALTH CARE, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark B. Petersen
- Title
- President
- Phone
- (309) 691-8113
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0046094 | IL | Primary |
Addresses
Primary practice location
129 S 1St Ave
Canton, IL 61520-2612
Mailing address
830 W Trailcreek Dr
Peoria, IL 61614-1862
Phone (309) 691-8113
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 37-1068286001 | Medicaid | IL |
Other names 1
- Sunset Rehabilitation & Health Care
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141013001925 | IL | Part A Provider - Skilled Nursing Facility | 7012137177 | Practice locations: Canton, IL |
Skilled nursing facility certification: CCN 146016
- Legal name
- PETERSEN HEALTH JUNCTION LLC
- Doing business as
- SUNSET REHABILITATION & HEALTH CARE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Jan 7, 2002
- Last certification
- Nov 21, 2024
- Beds
- 115
- Ownership / control type
- Corporation
- Multi-facility organization
- Petersen Healthcare
- Organization structure
- LLC
- Incorporated
- Feb 1, 2013 in IL
- Enrollment address
- 129S 1St Ave
Canton, IL 61520-2612
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Sunset Rehabilitation and Health Care
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 7, 2002
- Medicare certification status
- Active
- Certified beds
- 115
- Penalties (3 years)
- 4
National Provider Directory
National Provider Directory- Part of
- Petersen Health Care Inc
Locations
4656 W Kimberly Rd
Davenport, IA 52806
Phone (563) 391-5150
120 S Canton 1St Ave
Canton, IL 61614
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Mark B Petersen | 5% Or Greater Indirect Ownership Interest | Aug 12, 2003 | 99% |
| Corporate Officer | Aug 12, 2003 | 99% | |
| Operational/Managerial Control | Aug 12, 2003 | 99% | |
| Michelle Hansmeyer | W-2 Managing Employee | Sep 15, 2014 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145577600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1707868800000",
"number": "1104882919",
"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",
"fax_number": "309-691-8622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "129 S 1ST AVE",
"city": "CANTON",
"state": "IL",
"postal_code": "615202612",
"telephone_number": "309-647-4327",
"fax_number": "309-647-4354"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PETERSEN HEALTH JUNCTION, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PETERSEN HEALTH CARE, INC.",
"enumeration_date": "2006-04-21",
"last_updated": "2024-02-14",
"certification_date": "2024-02-14",
"status": "A",
"authorized_official_last_name": "PETERSEN",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "B.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "309-691-8113"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IL",
"license": "0046094",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "37-1068286001",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Sunset Rehabilitation & Health Care",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Canton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.