PETERSEN HEALTH QUALITY LLC NPI 1598721383

NPI Information

  • NPI: 1598721383
  • Provider Name: PETERSEN HEALTH QUALITY, LLC
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Doing Business As: COUNTRYVIEW TERRACE
  • Address: 52 OLD RTE 45
    LOUISVILLE, IL
    ZIP 62858
  • Phone: (618) 686-4542

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NPI Details

PETERSEN HEALTH QUALITY, LLC is an intermediate care facility mentally retarded in Louisville, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PETERSEN HEALTH QUALITY, LLC NPI is 1598721383. The provider is registered as an organization entity type.
The provider Is Doing Business As Countryview Terrace.

The provider's business location address is:

52 OLD RTE 45
LOUISVILLE, IL
ZIP 62858-116
Phone: (618) 686-4542
Fax: (618) 686-2179

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 enumeration date for this NPI number is 4/21/2006 and was last updated on 2/14/2024.

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
1315P00000XIntermediate Care Facility, Intellectual Disabilities0046078ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
137-1068286008MEDICAIDILLINOIS

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: 11/21/2025

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