Sullivan Hco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0046425 Issued in IL

Legal business name

SULLIVAN HCO, LLC

Doing business as

Sullivan Rehabilitation & Health Care Center

Practice address

11 Hawthorne LN
Sullivan, IL 61951-9490

Phone

(217) 728-4327

Fax

(217) 728-2263

NPI assigned

Apr 26, 2006

Last updated

Sep 24, 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

• Sullivan Rehabilitation & Health Care Center Doing business as

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1417913583",
    "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": "11 HAWTHORNE LN",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619519490",
            "telephone_number": "217-728-4327",
            "fax_number": "217-728-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "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": "0046425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "743055934006",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sullivan Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rita Seelow
• Amanda Sides, LPN
• Mary Stutzman, CRSS
• Sullivan Comm Unit School District 300
• Sullivan Hco, LLC
• Sullivan Healthcare & Senior Living LLC
• Sullivan Senior Living LLC (Heritage Woods of Sullivan)
• Nell Sundra
• Mohammad Tabatabaei, P.A.-C
• Thomas C. Best, O.D.

• Skilled Nursing Facility in Sullivan, IL
• Providers in Sullivan, 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 24, 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.