McLeansboro Hco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0047498 Issued in IL

Legal business name

MCLEANSBORO HCO, LLC

Doing business as

McLeansboro Rehabilitation & Health Care Center

Practice address

405 W Carpenter St
MC Leansboro, IL 62859-1012

Phone

(618) 643-3728

Fax

(618) 643-2330

NPI assigned

Jun 4, 2006

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

• McLeansboro Rehabilitation & Health Care Center Doing business as

Member of 1

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

• Petersen Health Operations, LLC

  dba Eastside Rehabilitation & Health Care Center

  • Skilled Nursing Facility
  • Pittsfield, IL
  • NPI 1285672766

  Member Of

  NPD member

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1801834387",
    "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": "405 W CARPENTER ST",
            "city": "MC LEANSBORO",
            "state": "IL",
            "postal_code": "628591012",
            "telephone_number": "618-643-3728",
            "fax_number": "618-643-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEANSBORO HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "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": "0047498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20-3224201014",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLeansboro Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McLeansboro Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Martha J Inman (Discount Medical Warehouse)
• Tina Lea Mayberry, SLP
• Teresa Kay McFarland-Miller, MSW, LCSW
• Gregory McFarland, PHARMD
• McLeansboro Hco, LLC
• Candace Lee Mitchell, COTA
• Donald Eugene Mitchell, M.D.
• Christopher Moore, DO
• Lilly Lynn Mosby I, BEHAVIOR TECHNICIAN
• Kadhiresan Murugappan, MD SC

• Skilled Nursing Facility in McLeansboro, IL
• Providers in McLeansboro, 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 15, 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.