NPIMap

Organization Active NPI

Petersen Health Systems, Inc

Doing business as Courtyard Estates of Knoxville

  • Assisted Living Facility
  • Knoxville, IL
National Provider Identifier
1447616347
Registry record updated Jan 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
5105348 Issued in IL
Legal business name
PETERSEN HEALTH SYSTEMS, INC
Doing business as
Courtyard Estates of Knoxville
Practice address
415 E Main St
Knoxville, IL 61448-1330
Phone
(309) 289-2660
NPI assigned
Jan 7, 2016
Last updated
Jan 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marikay Snyder
Title
General Counsel
Phone
(309) 691-8113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 5105348 IL Primary

Addresses

Primary practice location

415 E Main St
Knoxville, IL 61448-1330

Mailing address

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

Other names 1

  • Courtyard Estates of Knoxville Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2192574Courtyard Estates of Knoxville415 E Main St, Knoxville, IL 61448Certificate of waiverSep 10, 2026

National Provider Directory

National Provider Directory
Tax ID family
Courtyard Estates at Kewanee7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1452124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452124800000",
    "number": "1447616347",
    "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": "415 E MAIN ST",
            "city": "KNOXVILLE",
            "state": "IL",
            "postal_code": "614481330",
            "telephone_number": "309-289-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-07",
        "last_updated": "2016-01-07",
        "status": "A",
        "authorized_official_last_name": "SNYDER",
        "authorized_official_first_name": "MARIKAY",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "309-691-8113"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": "5105348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Courtyard Estates of Knoxville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Knoxville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.