Petersen Management Company, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0046615 Issued in IL

Legal business name

PETERSEN MANAGEMENT COMPANY, LLC

Practice address

232 Given Dr
Flora, IL 62839-1094

Phone

(618) 662-8381

Fax

(618) 662-9340

NPI assigned

Apr 21, 2006

Organization subpart

Yes

Parent organization

PETERSEN HEALTH CARE II, INC.As reported in NPPES

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

Addresses

Other identifiers 1

Other names 1

• Flora Rehabilitation & Health Care Center Doing business as

Part of

Petersen Health Care LL Inc

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369267200000",
    "number": "1326004136",
    "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": "232 GIVEN DR",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628391094",
            "telephone_number": "618-662-8381",
            "fax_number": "618-662-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN MANAGEMENT COMPANY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PETERSEN HEALTH CARE II, INC.",
        "enumeration_date": "2006-04-21",
        "last_updated": "2013-05-23",
        "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": "0046615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74-3055934009",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Flora Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bryce Pearce
• Jessica Perry, MA, LCPC
• Petersen Companies, LLC
• Petersen Health Care II, Inc
• Petersen Health Network, LLC
• Christina Pierson, RN
• Ponciano Pormentira Jr., DPT
• John Dale Powless, RPH
• Robert C Powless, RPH
• Bryton Pruett

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2013; 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.