NPIMap

Organization Active NPI

Petersen Health Properties, LLC

  • Skilled Nursing Facility
  • South Elgin, IL
National Provider Identifier
1730112939
Registry record updated Dec 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0047621 Issued in IL
Legal business name
PETERSEN HEALTH PROPERTIES, LLC
Practice address
746 W Spring St
South Elgin, IL 60177-1424
Phone
(847) 697-0565
Fax
(847) 697-0568
NPI assigned
Jul 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2019

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) 691-8113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0047621 IL Primary

Addresses

Primary practice location

746 W Spring St
South Elgin, IL 60177-1424

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
213224201010MedicaidIL

Other names 1

  • South Elgin Rehabilitation & Health 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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1730112939",
    "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": "746 W SPRING ST",
            "city": "SOUTH ELGIN",
            "state": "IL",
            "postal_code": "601771424",
            "telephone_number": "847-697-0565",
            "fax_number": "847-697-0568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH PROPERTIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "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": "309-691-8113"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0047621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213224201010",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Elgin Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Elgin Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Elgin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; 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.