Kewanee Hco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0026518 Issued in IL

Legal business name

KEWANEE HCO, LLC

Doing business as

Kewanee Care Home

Practice address

144 Junior Ave
Kewanee, IL 61443-2554

Phone

(309) 853-4429

Fax

(309) 853-9209

NPI assigned

Apr 21, 2006

Last updated

Sep 14, 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

• Kewanee Care Home Doing business as

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

CLIA laboratory certificates

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600041600000",
    "number": "1649236449",
    "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": "144 JUNIOR AVE",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614432554",
            "telephone_number": "309-853-4429",
            "fax_number": "309-853-9209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEWANEE HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "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": "0026518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37-1068286001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kewanee Care Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kewanee Care Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Kewanee, IL
• Providers in Kewanee, 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 14, 2020; 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.