Shelbyville Hco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SHELBYVILLE HCO, LLC

Practice address

2116 W South 3Rd St
Shelbyville, IL 62565-9102

Phone

(217) 774-2128

NPI assigned

Feb 17, 2020

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) 691-8113

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581897600000",
    "number": "1912530189",
    "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": "309-689-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2116 W SOUTH 3RD ST",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625659102",
            "telephone_number": "217-774-2128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBYVILLE HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby County Community Services Inc
• Shelby County Community Services Inc
• Shelby Home Medical Equipment, Inc.
• Shelbyville Comm Unit School Dist. 4
• Shelbyville Hco, LLC (Shelbyville Rehabilitation & Health Care Center)
• Shelbyville Healthcare & Senior Living LLC
• Hannah Shoaff
• Thomas Shoaff
• Edwin J Siroy, MD
• Shelle D Sloan, APN-NP

• Skilled Nursing Facility in Shelbyville, IL
• Providers in Shelbyville, 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 17, 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.