PA Peterson LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PA PETERSON LLC

Doing business as

The Villa at PA Peterson

Practice address

1311 Parkview Ave
Rockford, IL 61107-1818

Phone

(815) 399-8832

Fax

(815) 399-8342

NPI assigned

Jun 9, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Frances Meehan

Title

Attorney

Phone

(312) 521-2467

Specialties & licenses 1

Addresses

Other names 1

• The Villa at PA Peterson Doing business as

Locations

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

{
    "created_epoch": "1402272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402272000000",
    "number": "1891108668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 SHAFER CT",
            "address_2": "SUITE 475",
            "city": "ROSEMONT",
            "state": "IL",
            "postal_code": "600184914",
            "telephone_number": "815-399-8832",
            "fax_number": "815-399-8342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 PARKVIEW AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071818",
            "telephone_number": "815-399-8832",
            "fax_number": "815-399-8342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PA PETERSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-09",
        "last_updated": "2014-06-09",
        "status": "A",
        "authorized_official_last_name": "MEEHAN",
        "authorized_official_first_name": "FRANCES",
        "authorized_official_title_or_position": "ATTORNEY",
        "authorized_official_telephone_number": "312-521-2467",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Villa at PA Peterson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Moses Kwabena Owusu
• Mark A Oyer, MD
• Donna Jean Oyston, NP
• Erin Margaret Ozminkowski
• PA Peterson at the Citadel LLC
• Douglas Joseph Pacaccio, DPM
• Adriana Carolina Padron, DMD
• Andrea Padron, BSN
• Ixchel Pagan, LMT
• Pain Centers of Chicago LLC

• Skilled Nursing Facility in Rockford, IL
• Providers in Rockford, 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 Jun 9, 2014; 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.