SULLIVAN REHABILITATION & HEALTH CARE CENTER
NPI 1376794511
Skilled Nursing Facility in Sullivan, IL

NPI Status: Active since October 07, 2008

Contact Information

11 HAWTHORNE LN
SULLIVAN, IL
ZIP 61951
Phone: (217) 728-4327

NPI Profile Information
Primary Taxonomy
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Skilled Nursing Facility
CLIA Number: 14D0886003
CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
CLIA Exp. Date: 05-10-2026

About SULLIVAN REHABILITATION & HEALTH CARE CENTER

This page provides the complete NPI Profile along with additional information for Sullivan Rehabilitation & Health Care Center, a provider established in Sullivan, Illinois operating as a Skilled Nursing Facility. The healthcare provider is registered in the NPI registry with number 1376794511 assigned on October 2008. The practitioner's primary taxonomy code is 314000000X with license number 0046425 (IL). The provider is registered as an organization and their NPI record was last updated 5 years ago. The provider's is doing business as Sullivan Rehabilitation & Health Care Center. The authorized official of this NPI record is Mark B. Petersen (Manager)

NPI: 1376794511
Provider Legal Name: PETERSEN HEALTH CARE II, INC.
Other Organization Name: SULLIVAN REHABILITATION & HEALTH CARE CENTER
Other Name Type: Doing Business As (3)
Entity Type: Organization
Location Address: 11 HAWTHORNE LN SULLIVAN, IL 61951
Location Phone: (217) 728-4327
Mailing Address: 830 W TRAILCREEK DR PEORIA, IL 61614
Mailing Phone: (309) 691-8113
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 10-07-2008
Last Update Date: 05-19-2020
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Skilled Nursing Facility
Taxonomy Code: 314000000X
Type: Nursing & Custodial Care Facilities
License No.: 0046425
License State: IL
Taxonomy Description: (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.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: MARK B. PETERSEN
Authorized Official Title: MANAGER
Authorized Official Phone: (309) 689-5880

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 14D0886003
Facility Type: Skilled Nursing Facility/Nursing Facility
Certificate Effective Date: May 11, 2024
Certificate Expiration Date: May 10, 2026
Laboratory Director: JANELLE R. HOLTHAUS
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Sullivan Rehabilitation & Health Care Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	3	7	6	7	9	4	5	1	1
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	3	14	6	14	9	8	5	2
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 3 + 1 + 4 + 6 + 1 + 4 + 9 + 8 + 5 + 2 + 24 = 69
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 69 = 1									1

The NPI number 1376794511 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.