Petersen Health Care Roseville LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PETERSEN HEALTH CARE ROSEVILLE LLC

Doing business as

Roseville Rehabilitation & Health Care

Practice address

145 S Chamberlain St
Roseville, IL 61473-9581

Phone

(309) 691-8113

NPI assigned

Mar 20, 2010

Last updated

Feb 14, 2024By 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 Petersen

Title

Manager

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Other names 1

• Roseville Rehabilitation & Health Care Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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": "1269043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1710201793",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 S CHAMBERLAIN ST",
            "city": "ROSEVILLE",
            "state": "IL",
            "postal_code": "614739581",
            "telephone_number": "309-691-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH CARE ROSEVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-20",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "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"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roseville Rehabilitation & Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy B Huston III
• Jayme Renee Johnson, PTA
• Ward Scott Jones, DDS
• Ronald Leonard
• Osf Healthcare System (OSF Holy Family Medical Center)
• Roseville Area Ambulance SVC
• Brittni Zimmerman, M.S., CCC-SLP

• Skilled Nursing Facility in Roseville, IL
• Providers in Roseville, 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 Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.