FONDULAC REHABILITATION & HEALTH CARE CENTER
NPI 1548414550
Skilled Nursing Facility in East Peoria, IL
- Organization
- Skilled Nursing Facility
- CLIA Number: 14D0858580
- CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
- CLIA Exp. Date: 08-31-2026
About FONDULAC REHABILITATION & HEALTH CARE CENTER
This page provides the complete NPI Profile along with additional information for Fondulac Rehabilitation & Health Care Center, a provider established in East Peoria, Illinois operating as a Skilled Nursing Facility. The healthcare provider is registered in the NPI registry with number 1548414550 assigned on November 2008. The practitioner's primary taxonomy code is 314000000X with license number 0047472 (IL). The provider is registered as an organization and their NPI record was last updated 18 years ago. The provider's is doing business as Fondulac Rehabilitation & Health Care Center. The authorized official of this NPI record is Mark Petersen (Manager)
- NPI
- 1548414550 Verify this NPI
- Provider Legal Name
- PETERSEN HEALTH OPERATIONS
- Other Organization Name
- FONDULAC REHABILITATION & HEALTH CARE CENTER
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 901 ILLINI DR EAST PEORIA, IL 61611
- Location Phone
- (309) 694-6446
- Mailing Address
- 830 W TRAILCREEK DR PEORIA, IL 61614
- Mailing Phone
- (309) 691-8113
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-05-2008
- Last Update Date
- 11-05-2008
- Code Navigator
Location Map
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.
- 0047472
- 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.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| =========039 | MEDICAID (05) | IL |
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
- 14D0858580
- Facility Type
- Skilled Nursing Facility/Nursing Facility
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- SHAWNNA R. MAYER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Fondulac 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.
Reviews for FONDULAC REHABILITATION & HEALTH CARE CENTER
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
Other Providers at the Same Location
The following 3 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1548414550, enumerated as an "organization" on November 05, 2008.
The provider is located at 901 ILLINI DR EAST PEORIA, IL 61611 and the phone number is (309) 694-6446.
Skilled Nursing Facility with taxonomy code 314000000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
