NPIMap

Organization Active NPI

Petersen Health Network, LLC

Doing business as Flora Gardens Care Center

  • Skilled Nursing Facility
  • Flora, IL
National Provider Identifier
1275622003
Registry record updated Mar 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0038760 Issued in IL
Legal business name
PETERSEN HEALTH NETWORK, LLC
Doing business as
Flora Gardens Care Center
Practice address
701 Shadwell Ave
Flora, IL 62839-2310
Phone
(618) 662-8361
Fax
(618) 662-2811
NPI assigned
Oct 12, 2006
Last updated
Mar 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2017

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)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0038760 IL Primary

Addresses

Primary practice location

701 Shadwell Ave
Flora, IL 62839-2310

Mailing address

830 W Trailcreek Dr
Peoria, IL 61614-1862
Phone (309) 691-8113

Other names 1

  • Flora Gardens Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Flora Gardens Care Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489795200000",
    "number": "1275622003",
    "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": "701 SHADWELL AVE",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628392310",
            "telephone_number": "618-662-8361",
            "fax_number": "618-662-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2017-03-18",
        "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": "0038760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Flora Gardens Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2017; 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.