Petersen Health & Wellness, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PETERSEN HEALTH & WELLNESS, LLC

Doing business as

Enfield Rehabilitation & Health Care Center

Practice address

408 N. Wilson
Box 285
Enfield, IL 62835

Phone

(618) 963-2331

Fax

(618) 963-2083

NPI assigned

Jun 14, 2006

Last updated

Aug 1, 2016By 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

Manage

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Enfield Rehabilitation & Health Care Center Doing business as

Locations

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470009600000",
    "number": "1346283587",
    "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": "408 N. WILSON",
            "address_2": "BOX 285",
            "city": "ENFIELD",
            "state": "IL",
            "postal_code": "62835",
            "telephone_number": "618-963-2331",
            "fax_number": "618-963-2083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2016-08-01",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "MANAGE",
        "authorized_official_telephone_number": "309-691-8113"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20-3224201009",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Enfield Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan Chabot
• Brooklyn Naas
• Michelle Prather, OTR/L

• Skilled Nursing Facility in Enfield, IL
• Providers in Enfield, 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 Aug 1, 2016; 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.