Petersen Management Company, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PETERSEN MANAGEMENT COMPANY, LLC

Doing business as

White Oak Rehabilitation & Health Care Center

Practice address

1700 White St
Mount Vernon, IL 62864-4349

Phone

(618) 242-4075

Fax

(618) 242-4092

NPI assigned

Jul 9, 2006

Last updated

May 23, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

PETERSEN HEALTH CARE II, INCAs reported in NPPES

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

Authorized official

Name

Mark B. Petersen

Title

President

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• White Oak Rehabilitation & Health Care Center Doing business as

Part of

Petersen Health Care II Inc

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369267200000",
    "number": "1932132115",
    "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": "1700 WHITE ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644349",
            "telephone_number": "618-242-4075",
            "fax_number": "618-242-4092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN MANAGEMENT COMPANY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PETERSEN HEALTH CARE II, INC",
        "enumeration_date": "2006-07-09",
        "last_updated": "2013-05-23",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-691-8113"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "743055934014",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Oak Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Patrick Henry Perkins, CRNA
• Edward E Perry, O.D.
• Kimberly Lisa Joan Perry, LPN
• Petersen Health Care LL, Inc. (New Horizons Rehabilitation & Health Care Center)
• Petersen Management Company, LLC (Mt. Vernon Health Care Center)
• Cynthia Dawn Phillips, APN
• Jaylyn Phillips
• Shima Phoenix, DMD
• Physician Rural Health Clinic of Jefferson County
• Physician Services Corp of Southern Illinois (St marys Good Samaritan medical group)

• Skilled Nursing Facility in Mount Vernon, IL
• Providers in Mount Vernon, 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 May 23, 2013; 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.