FONDULAC REHABILITATION & HEALTH CARE CENTER
NPI 1235176504
Skilled Nursing Facility in East Peoria, IL

Active since June 02, 2006CLIA 14D0858580 · Waiver
901 ILLINI DR, EAST PEORIA, IL 61611(309) 694-6446(309) 694-8705 Get Directions Write a Review

NPPES record last updated: January 19, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 19, 2022, Aug 17, 2018 (2 updates tracked since 2018).

About Fondulac Rehabilitation & Health Care Center NPPES

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

FONDULAC REHABILITATION & HEALTH CARE CENTER (NPI 1235176504) is a healthcare organization registered as a skilled nursing facility in East Peoria, 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, General Manager, as its authorized official.

NPPES Registry Identity

NPI1235176504
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NamePETERSEN HEALTH OPERATIONS, LLC
Location Address901 ILLINI DREast Peoria, IL 61611-1840
Mailing Address830 W Trailcreek DrPeoria, IL 61614-1862 · (309) 691-8113 · Fax (309) 691-8622
Fax(309) 694-8705
Organization SubpartNo
Authorized OfficialMark B. PetersenGeneral Manager · (309) 691-8113
Enumeration DateJune 2, 2006
Last NPPES UpdateJanuary 19, 20222 updates tracked since enumeration
NPPES CertifiedJanuary 19, 2022
NPI 1235176504 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in IL · 0047472
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
901 ILLINI DR, East Peoria, IL 61611

Other Names 1

Doing Business AsFondulac Rehabilitation & Health Care Center

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 14D0858580

Fondulac Rehabilitation & Health Care Center Petersen Health Operations LLC · East Peoria, IL
Active · expires Aug 31, 2026
CLIA Number14D0858580
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorShawnna R. Mayer
Laboratory Phone(309) 694-6446
Laboratory LocationFondulac Rehabilitation & Health Care Center Petersen Health Operations LLC901 Illini Dr, East Peoria, IL 61611
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 3

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

Skilled Nursing Facility
901 ILLINI DR
EAST PEORIA, IL 61611
Speech-Language Pathologist
901 ILLINI DR
EAST PEORIA, IL 61611
Skilled Nursing Facility
901 ILLINI DR
EAST PEORIA, IL 61611

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Petersen Health Operations, LLC's NPI number?

The NPI number for Petersen Health Operations, LLC is 1235176504. It was assigned to this organization in the NPPES registry on June 2, 2006. The provider is doing business as Fondulac Rehabilitation & Health Care Center.

Where is Petersen Health Operations, LLC located?

Petersen Health Operations, LLC is located at 901 Illini Dr, East Peoria, IL 61611. The listed phone number is (309) 694-6446.

What is Petersen Health Operations, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Petersen Health Operations, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D0858580) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Petersen Health Operations, LLC was last updated on January 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.