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MT. VERNON HEALTH CARE CENTER
NPI 1780767897
Nursing Facility/Intermediate Care Facility in Mount Vernon, IL

Active since October 23, 2006
5 DOCTORS PARK RD, MOUNT VERNON, IL 62864(618) 242-1064(618) 242-7559 Get Directions Write a Review

NPPES record last updated: May 30, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mt. Vernon Health Care Center NPPES

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

MT. VERNON HEALTH CARE CENTER (NPI 1780767897) is a healthcare organization registered as a nursing facility/intermediate care facility in Mount Vernon, Illinois and active in the NPI registry since October 2006. The organization lists Mark B. Petersen, President, as its authorized official.

NPPES Registry Identity

NPI1780767897
Entity TypeOrganization
Primary Taxonomy313M00000X
Legal Business NamePETERSEN MANAGEMENT COMPANY, LLC
Location Address5 DOCTORS PARK RDMount Vernon, IL 62864-6224
Mailing Address830 W Trailcreek DrPeoria, IL 61614-1862 · (309) 691-8113 · Fax (309) 691-8622
Phone(618) 242-1064
Fax(618) 242-7559
Organization SubpartYesParent: Petersen Health Care Ii, Inc.
Authorized OfficialMark B. PetersenPresident · (309) 691-8113
Enumeration DateOctober 23, 2006
Last NPPES UpdateMay 30, 2013
✔ NPI 1780767897 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 · 0039800
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.
5 DOCTORS PARK RD, Mount Vernon, IL 62864
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Other Names 1

Doing Business AsMt. Vernon Health Care Center

Other Identifiers 1

Medicaid391516877001IL

Other Providers at the Same Location NPPES 4

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

AMANDA JO PORTER OTR/L
Occupational Therapist
5 DOCTORS PARK RD
MOUNT VERNON, IL 62864
Jefferson County (618) 242-1064
AXIOM GARDENS OF MOUNT VERNON LLC
Durable Medical Equipment & Medical Supplies
5 DOCTORS PARK RD
MOUNT VERNON, IL 62864
Jefferson County (618) 242-1064
CARAVILLA RESIDENTIAL CENTERS, INC
Nursing Facility/Intermediate Care Facility
5 DOCTORS PARK RD
MOUNT VERNON, IL 62864
Jefferson County (618) 242-1064
AXIOM GARDENS OF MOUNT VERNON LLC
Skilled Nursing Facility
5 DOCTORS PARK RD
MOUNT VERNON, IL 62864
Jefferson County (618) 242-1064

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 Management Company, LLC's NPI number?

The NPI number for Petersen Management Company, LLC is 1780767897. It was assigned to this organization in the NPPES registry on October 23, 2006. The provider is doing business as Mt. Vernon Health Care Center.

Where is Petersen Management Company, LLC located?

Petersen Management Company, LLC is located at 5 Doctors Park Rd, Mount Vernon, IL 62864. The listed phone number is (618) 242-1064.

What is Petersen Management Company, LLC's specialty?

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

When was this NPI record last updated?

The NPPES record for Petersen Management Company, LLC was last updated on May 30, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.