Petersen Health Care - Farmer City, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

000041251 Issued in IL

Legal business name

PETERSEN HEALTH CARE - FARMER CITY, LLC

Doing business as

Farmer City Rehab & Health Care

Practice address

404 Brookview Dr
Farmer City, IL 61842-9746

Phone

(309) 691-8113

Fax

(309) 689-8622

NPI assigned

Jan 11, 2006

Last updated

Jan 28, 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

Mr. Mark Petersen

Title

Manager

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Farmer City Rehab & Health Care Doing business as

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580169600000",
    "number": "1487633269",
    "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": "309-691-1862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 BROOKVIEW DR",
            "city": "FARMER CITY",
            "state": "IL",
            "postal_code": "618429746",
            "telephone_number": "309-691-8113",
            "fax_number": "309-689-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH CARE - FARMER CITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-11",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "000041251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300318970008",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Farmer City Rehab & Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Farmer City Rehab & Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bobbi S Kennedy
• Kris Erin Knox, ATC
• Mimi Marks, M.T.
• Kara Lynn Moody, APN
• Petersen Health Care - Farmer City (Farmer City Rehab & Health Care)
• Aaron G. Skinner, D.C.
• Patricia J Spurlock, D.C.
• Kara Stockwill

• Skilled Nursing Facility in Farmer City, IL
• Providers in Farmer City, 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 Jan 28, 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.