Westside Hco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0053488 Issued in IL

Legal business name

WESTSIDE HCO, LLC

Doing business as

Westside Rehabilitation & Care Center

Practice address

601 N Columbia St
West Frankfort, IL 62896-1859

Phone

(618) 932-2109

NPI assigned

Apr 6, 2009

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 names 1

• Westside Rehabilitation & Care Center 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": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606867200000",
    "number": "1811139876",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N COLUMBIA ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628961859",
            "telephone_number": "618-932-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "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": "0053488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westside Rehabilitation & Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Westside Rehabilitation & Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• West Frankfort Cu Dist 168
• West Frankfort Family Care LLC
• Valerie West
• Beth Westell, O.D.
• Westside Hco, LLC
• Krysten Taylor Whitehead, APRN FNP-C
• Tamonte Whitelow
• Kelley Whitener
• Johann Wichmann, M.S.ED
• Kane Wilburn

• Skilled Nursing Facility in West Frankfort, IL
• Providers in West Frankfort, 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 Dec 2, 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.