Petersen Health Care, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

820624 Issued in IA

Legal business name

PETERSEN HEALTH CARE, INC.

Doing business as

Meadowlawn Health Care

Practice address

4656 W Kimberly Rd
Davenport, IA 52806-7111

Phone

(563) 391-5150

Fax

(563) 391-3901

NPI assigned

Apr 21, 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

President

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Meadowlawn Health Care Doing business as

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962468769",
    "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": "4656 W KIMBERLY RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528067111",
            "telephone_number": "563-391-5150",
            "fax_number": "563-391-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2020-08-22",
        "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": "IA",
            "license": "820624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0809459",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadowlawn Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Performance Psychiatric Consults LLC
• Charlene Marie Perkins, RN,LCCE,CD(DONA)
• Brittany Francisca Pernell, LMHC
• Michael Charles Persson Jr., M.D.
• Kathy Peters, DC
• Sara Katherine Petersen, PT, DPT
• Amanda Jane Peterson
• Greg Robert Peterson
• Alyssa Allyson Petroni
• Joseph M Phelan, MD

• Skilled Nursing Facility in Davenport, IA
• Providers in Davenport, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.