DECATUR REHABILITATION & HEALTH CARE CENTER - NPI 1063459329 - Nursing Facility/Intermediate Care Facility in Decatur, IL

Q: What is Decatur Hco, LLC's NPI number?

The NPI number for Decatur Hco, LLC is 1063459329. It was assigned to this organization in the NPPES registry on June 2, 2006.

Q: What is Decatur Hco, LLC's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Q: When was this NPI record last updated?

The NPPES record for Decatur Hco, LLC was last updated on December 10, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Decatur Rehabilitation & Health Care Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DECATUR REHABILITATION & HEALTH CARE CENTER (NPI 1063459329) is a healthcare organization registered as a nursing facility/intermediate care facility in Decatur, Illinois and active in the NPI registry since June 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Mark B. Petersen, Manager, as its authorized official.

NPPES Registry Identity

NPI1063459329

Entity TypeOrganization

Primary Taxonomy313M00000X

Legal Business NameDECATUR HCO, LLC

Location Address136 S DIPPER LNDecatur, IL 62522-1841

Mailing Address830 W Trailcreek DrPeoria, IL 61614-1862 · (309) 691-8113 · Fax (309) 691-8622

Phone(217) 428-7767

Fax(217) 428-7454

Organization SubpartNo

Authorized OfficialMark B. PetersenManager · (309) 689-5880

Enumeration DateJune 2, 2006

Last NPPES UpdateDecember 10, 2020

NPPES CertifiedDecember 10, 2020

✔ NPI 1063459329 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities

Taxonomy Code313M00000X

License✔ Licensed in IL · 0043455

Definition

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.

136 S DIPPER LN, Decatur, IL 62522

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Other Names 1

Doing Business AsDecatur Rehabilitation & Health Care Center

Other Identifiers 1

Medicaid20-3224201009IL

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0434997

Decatur Rehabilitation & Health Care Center · Decatur, IL

Active · expires Aug 31, 2026

CLIA Number14D0434997

Laboratory TypeSkilled Nursing Facility/Nursing Facility

Certificate Effective DateSeptember 1, 2024

Certificate Expiration DateAugust 31, 2026

Laboratory DirectorTracey Adams Stein

Laboratory Phone(217) 428-7767

Laboratory LocationDecatur Rehabilitation & Health Care Center136 S Dipper Lane, Decatur, IL 62522

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JODY VEALE

Occupational Therapist