Petersen Health Care - Nokomis, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0049114 Issued in IL

Legal business name

PETERSEN HEALTH CARE - NOKOMIS, LLC

Doing business as

Nokomis Rehabilitation & Health Care Center

Practice address

505 Stevens St
Nokomis, IL 62075-1442

Phone

(217) 563-7725

NPI assigned

Nov 5, 2008

Last updated

Nov 5, 2008By 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 Petersen

Title

Manager

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nokomis Rehabilitation & Health Care Center Doing business as

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1346494358",
    "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": "505 STEVENS ST",
            "city": "NOKOMIS",
            "state": "IL",
            "postal_code": "620751442",
            "telephone_number": "217-563-7725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH CARE - NOKOMIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "309-691-8113"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0049114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260372393003",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nokomis Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nokomis-Witt Area Ambulance Service Inc
• Pana Community Hospital Association (Community Medical Clinic of Nokomis)
• Pana Community Hospital Association (Community Medical Clinic of Nokomis)
• Pana Community Hospital Association (Community Medical Clinic of Nokomis)
• Pana Community Hosptial Association (Nokomis Medical Group)
• Petersen Health Network, LLC (Nokomis Rehabilitation & Health Care Center)
• Robert Gollon (Bob's Pharmacy)
• Springfield Clinic, LLP
• Nicole Tonette Stauder, P.T.

• Skilled Nursing Facility in Nokomis, IL
• Providers in Nokomis, 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 Nov 5, 2008; 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.