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PETERSEN HEALTH SYSTEMS INC NPI 1740362979


NPI Information

NPI: 1740362979
Provider Name: PETERSEN HEALTH SYSTEMS, INC

Doing Business As: COURTYARD VILLAGE OF KEWANEE

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 14D2192578

Address:
808 SUNSET DRIVE
KEWANEE, IL
ZIP 61443
Phone: (309) 853-4044
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PETERSEN HEALTH SYSTEMS, INC is an assisted living facility in Kewanee, IL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. PETERSEN HEALTH SYSTEMS, INC NPI is 1740362979. The provider is registered as an organization entity type.
The provider Is Doing Business As Courtyard Village Of Kewanee.

The provider's business location address is:

808 SUNSET DRIVE
KEWANEE, IL
ZIP 61443
Phone: (309) 853-4044
Fax: (309) 853-5014

The provider's authorized official is Mark B Petersen .
The authorized official title is President and has the following contact phone number (309) 691-8113.

The CLIA number assigned to this NPI record is 14D2192578 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/19/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living Facility5101537ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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