PETERSEN HEALTH & WELLNESS, LLC (NPI# 1063459329) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063459329 |
| Entity Type | Organization |
| Organization Name | PETERSEN HEALTH & WELLNESS, LLC |
| Other Organization Name | DECATUR REHABILITATION & HEALTH CARE CENTER |
| Practice Address |
136 S Dipper Ln Decatur IL 62522-1841 |
| Mailing Address |
830 W Trailcreek Dr Peoria IL 61614-1862 |
| Practice Telephone | 2174287767 |
| Practice Fax Number | 2174287454 |
| Mailing Telephone | 3096918113 |
| Mailing Fax Number | 3096918622 |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2014-10-09 |
| Authorized Official Name | MARK B. PETERSEN (MANAGER) |
| Authorized Official Telephone | 3096918113 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 0043455 | IL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 20-3224201009 | 05 |
| Other Name | Type Code |
|---|---|
| Decatur Rehabilitation & Health Care Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578646691 | Petersen Health & Wellness, LLC | Skilled Nursing Facility | 418 S Memorial Park Rd, Newman, IL 61942-8062 | 2006-10-23 |
| 1346283587 | Petersen Health & Wellness, LLC | Skilled Nursing Facility | 408 N. Wilson, Box 285, Enfield, IL 62835 | 2006-06-14 |
| 1528006004 | Petersen Health & Wellness, LLC | Skilled Nursing Facility | 430 Martin Rd, Rock Falls, IL 61071-1954 | 2006-06-04 |
| Street Address |
136 S DIPPER LN |
| City | DECATUR |
| State | IL |
| Zip Code | 62522-1841 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790318954 | Decatur Hco, LLC | Skilled Nursing Facility | 136 S Dipper Ln, Decatur, IL 62522-1841 | 2020-02-17 |
| 1073072609 | Jaycee Cabalatungan Cristales | Physical Therapist | 136 S Dipper Ln, Decatur, IL 62522-1841 | 2019-03-13 |
| 1912482415 | Eleanore Sharon Chan | Speech-Language Pathologist | 136 S Dipper Ln, Decatur, IL 62522-1841 | 2018-10-01 |
| 1700326717 | Jody Veale | Occupational Therapist | 136 S Dipper Ln, Decatur, IL 62522-1841 | 2017-02-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902370299 | Julie Ann Marsh | Psychologist | 7120 W. William St., Decatur, IL 62522 | 2019-01-20 |
| 1588808323 | Paul D. Potter, D.d.s., Ltd | Dentist | 280 West North St, Decatur, IL 62522 | 2009-04-23 |
| 1801059100 | Melissa Ann Burnett | Dentist | 301 W North Street, Decatur, IL 62522 | 2008-07-07 |
| 1801060538 | Ronald James Grason | Internal Medicine | 357 W Decatur St, Decatur, IL 62522 | 2008-04-14 |
| 1033328349 | Jurgens & Kneezel Ltd | Dentist | 334 W Main Street, Decatur, IL 62522 | 2007-05-22 |
| 1740371905 | Randy Curtis Kneezel | Dentist | 334 W Main, Decatur, IL 62522 | 2006-09-27 |
| 1457373375 | Patricia Elaine Norton | Dentist | 1099 W Wood St, Suite E, Decatur, IL 62522 | 2006-07-24 |
| 1104883735 | Stephen J Chadwick | Otolaryngology | 101 W Mckinley Ave, Enta Allergy, Head & Neck Institute, Decatur, IL 62522 | 2006-04-27 |
| 1417408386 | Heritage Behavioral Health Center | Community/Behavioral Health | 955 N Main St, Decatur, IL 62522 | 2016-10-17 |
| 1467522466 | Alan Russell Jurgens | Dentist | 334 W Main, Decatur, IL 62522 | 2006-11-08 |
| Find all providers in zip 62522 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568493930 | Sunny Hills Inc | Nursing Facility/Intermediate Care Facility | 201 E Thompson St, Decatur, TX 76234-2736 | 2006-07-05 |
| 1841229788 | Strategic Care of Decatur, LLC | Nursing Facility/Intermediate Care Facility | 201 E Thompson, Decatur, TX 76234 | 2006-07-02 |
| 1811391691 | Atlanta Va Medical Center | Nursing Facility/Intermediate Care Facility | 1670 Clairmont Rd, Decatur, GA 30033-4004 | 2014-10-22 |
| 1265477863 | Atlanta Va Medical Center | Nursing Facility/Intermediate Care Facility | 1670 Clairmont Rd, Decatur, GA 30033-4004 | 2006-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386094068 | Icg Home Health | Nursing Facility/Intermediate Care Facility | 4508 Camden Ct, Richton Park, IL 60471-1147 | 2016-06-14 |
| 1871999078 | Midwest Health Operations LLC | Nursing Facility/Intermediate Care Facility | 3601 16th Ave, Sterling, IL 61081-4059 | 2014-11-15 |
| 1437410891 | Mado Healthcare | Nursing Facility/Intermediate Care Facility | 1541 North Wells, Chicago, IL 60610-1307 | 2012-06-01 |
| 1134405392 | Faith Community Health Services, Inc | Nursing Facility/Intermediate Care Facility | 4449 177th St, Country Club Hills, IL 60478-4705 | 2011-11-01 |
| 1215188487 | Petersen Health Care, Inc | Nursing Facility/Intermediate Care Facility | 144 Jounior Ave., Kewanee, IL 61443 | 2008-10-07 |
| 1699936054 | Pinckneyville Healthcare Center | Nursing Facility/Intermediate Care Facility | 708 Virginia Ct, Pinckneyville, IL 62274-1538 | 2008-06-18 |
| 1184894412 | Parents and Friends of The Slc-home 1 | Nursing Facility/Intermediate Care Facility | 3 Gundlach Pl, Swansea, IL 62226-4227 | 2008-03-03 |
| 1740463074 | St. Joseph's Home of Springfield | Nursing Facility/Intermediate Care Facility | 3306 S 6th Street Rd, Springfield, IL 62703-4735 | 2007-12-10 |
| 1821283573 | Royal Living Center Inc | Nursing Facility/Intermediate Care Facility | 200 South 9th Street, New Baden, IL 62265 | 2007-09-06 |
| 1235323841 | Parents and Friends of Slc | Nursing Facility/Intermediate Care Facility | 1450 Caseyville Ave, Swansea, IL 62226-4517 | 2007-08-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.