Vandalia Hco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0043497 Issued in IL

Legal business name

VANDALIA HCO, LLC

Doing business as

Vandalia Rehabilitation & Health Care Center

Practice address

1500 W Saint Louis Ave
Vandalia, IL 62471-2535

Phone

(618) 283-4262

Fax

(618) 283-4313

NPI assigned

Sep 25, 2006

Last updated

Sep 2, 2020By the provider in NPPES

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 identifiers 1

Other names 1

• Vandalia Rehabilitation & Health Care Center Doing business as

Member of 1

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

• Petersen Health Operations, LLC

  dba Benton Rehabilitation & Health Care Center

  • Nursing Facility/Intermediate Care Facility
  • Benton, IL
  • NPI 1316047681

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1265532493",
    "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": "1500 W SAINT LOUIS AVE",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624712535",
            "telephone_number": "618-283-4262",
            "fax_number": "618-283-4313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDALIA HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "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": "0043497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203224201004",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vandalia Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vandalia Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Total Renal Care Inc (Vandalia Dialysis)
• Transforming Physical Therapy LTD (Transforming Physical Therapy & Wellness)
• Vandalia Cusd 203
• Vandalia Dental Associates, LLC
• Vandalia Estates, LLC
• Vandalia Hco, LLC
• Vandalia Healthcare & Senior Living LLC
• Vandalia Physical Therapy LTD (Transforming Physical Therapy)
• Vandalia Terrace, LTD
• Jennifer Renee Waggoner

• 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 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.