Petersen Health Care VII LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0010249 Issued in IL

Legal business name

PETERSEN HEALTH CARE VII LLC

Practice address

1 Masonic Way
Sullivan, IL 61951-9467

Phone

(217) 728-7394

Fax

(217) 728-4221

NPI assigned

Jan 4, 2006

Organization subpart

No

Name

Mr. Mark Petersen

Title

President

Phone

(309) 691-8113

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Effingham Hco, LLC

  • Skilled Nursing Facility
  • Effingham, IL
  • NPI 1336249614

  O20111116000122

  Same enrollment
• Petersen Health Care VII LLC

  • Skilled Nursing Facility
  • Harrisburg, IL
  • NPI 1225270283

  O20111116000122

  Same enrollment

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Effingham Hco, LLC

  • Skilled Nursing Facility
  • Effingham, IL
  • NPI 1336249614

  Member Of

  NPD member

Locations

• Mason Point Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 27, 2009.

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248652800000",
    "number": "1194703702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MASONIC WAY",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619519467",
            "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": "1 MASONIC WAY",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619519467",
            "telephone_number": "217-728-7394",
            "fax_number": "217-728-4221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH CARE VII LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-04",
        "last_updated": "2009-07-27",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-691-8113",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0010249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mason Point",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anne Margaret Osthoff, MS
• Patient First Chiropractic
• Patterson House, Inc
• Petersen Health Care II, Inc.
• Petersen Health Care II, Inc.
• Petersen Health Care, Inc
• Victoria Phelps, BS
• Alexandria Elizabeth Poe, LCSW
• Darby Lynn Poe, CRSS
• Kaylee Purcell

• All providers in Sullivan, IL
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.