NPIMap

Organization Active NPI

Lebanon Hco, LLC

  • Skilled Nursing Facility
  • Lebanon, IL
National Provider Identifier
1679550644
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0016964 Issued in IL
Legal business name
LEBANON HCO, LLC
Doing business as
Lebanon Care Center
Practice address
1201 N Alton St
Lebanon, IL 62254-1103
Phone
(618) 537-4401
NPI assigned
Dec 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0016964 IL Primary

Addresses

Primary practice location

1201 N Alton St
Lebanon, IL 62254-1103

Mailing address

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

Other names 1

  • Lebanon Care Center Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1679550644",
    "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": "1201 N ALTON ST",
            "city": "LEBANON",
            "state": "IL",
            "postal_code": "622541103",
            "telephone_number": "618-537-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEBANON HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "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": "0016964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lebanon Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lebanon Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.