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Contact Information

PETERSEN HEALTH CARE - ILLINI, LLC
1315 CURT DRIVE
CHAMPAIGN, IL61820
 Phone: 217-352-5707
 Fax: 217-352-2607
 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 CARE - ILLINI, LLC

NPI # 1619083730
LBN Legal business name PETERSEN HEALTH CARE - ILLINI, LLC
Authorized official MARK PETERSEN - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 08/22/2006
Last updated 02/14/2024 - About 2 years ago
Identifiers
IL License # 0042440
IL Medicaid 300318970007
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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