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Contact Information

PETERSEN HEALTH & WELLNESS, LLC
408 N. WILSON
BOX 285
ENFIELD, IL62835
 Phone: 618-963-2331
 Fax: 618-963-2083
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
Indicates primary specialty

NPI Profile & details for PETERSEN HEALTH & WELLNESS, LLC

NPI Number 1346283587
LBN Legal business name PETERSEN HEALTH & WELLNESS, LLC
Authorized official MARK PETERSEN - (MANAGE)
Entity Organization
Organization subpart 1 No
Enumeration date 06/14/2006
Last updated 08/01/2016 - About 10 years ago
Identifiers
IL Medicaid 20-3224201009
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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