Collinsville Hco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0048447 Issued in IL

Legal business name

COLLINSVILLE HCO, LLC

Practice address

614 N Summit Ave
Collinsville, IL 62234

Phone

(618) 344-8476

Fax

(618) 344-8483

NPI assigned

Sep 22, 2006

Organization subpart

No

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

Authorized official

Name

Mark B. Petersen

Title

Manager

Phone

(309) 689-5880

Specialties & licenses 1

Addresses

Other names 2

• Collinsville Rehabilitation & Health Care Doing business as
• Collinsville Rehabilitation & Health Care Center Doing business as

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1265532022",
    "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": "614 N SUMMIT AVE",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "62234",
            "telephone_number": "618-344-8476",
            "fax_number": "618-344-8483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINSVILLE HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "309-689-5880"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0048447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collinsville Rehabilitation & Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Collinsville Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor Cipicchio
• City of Collinsville
• Benjamin Clark, LPC
• Jane Clarkston
• Cole Vision Corporation
• Collinsville Hco, LLC
• Collinsville Orthodontics PLLC
• Collinsville Pediatric Dentistry PLLC
• Collinsville Physical Therapy & Wellness, LLC
• Collinsville Unit School District #10

• Skilled Nursing Facility in Collinsville, IL
• Providers in Collinsville, 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 Sep 2, 2020; 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.