Prairie City Hco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

146038 Issued in IL

Legal business name

PRAIRIE CITY HCO, LLC

Doing business as

Prairie City Rehab & Health Care

Practice address

825 E Main St
Prairie City, IL 61470-9411

Phone

(309) 775-3313

Fax

(309) 775-3311

NPI assigned

Aug 23, 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 2

Addresses

Other identifiers 1

Other names 1

• Prairie City Rehab & Health Care Doing business as

Member of 1

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

• Tarkio Hco, LLC

  • Skilled Nursing Facility
  • Tarkio, MO
  • NPI 1114253127

  Member Of

  NPD member

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1932215548",
    "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": "825 E MAIN ST",
            "city": "PRAIRIE CITY",
            "state": "IL",
            "postal_code": "614709411",
            "telephone_number": "309-775-3313",
            "fax_number": "309-775-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE CITY HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "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": "146038",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0045377",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0045377",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie City Rehab & Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prairie City Rehab & Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edward Allen McEwen, PT
• Prairie City Hco, LLC
• Linda Kay Worthington, SLP-CCC/L

• Skilled Nursing Facility in Prairie City, IL
• Providers in Prairie City, 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.