1. Home
  2. Directory
  3. Illinois
  4. Monmouth
  5. Assisted Living Facility
  6. NPI Profile

LEGACY ESTATES OF MONMOUTH
NPI 1841460029
Assisted Living Facility in Monmouth, IL

Active since March 04, 2008CLIA 14D2192582 · Waiver
1200 W BROADWAY, MONMOUTH, IL 61462(309) 734-0909 Get Directions Write a Review

NPPES record last updated: April 20, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Legacy Estates Of Monmouth NPPES

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

LEGACY ESTATES OF MONMOUTH (NPI 1841460029) is a healthcare organization registered as an assisted living facility in Monmouth, Illinois and active in the NPI registry since March 2008. The organization holds a CLIA Waiver certificate valid through September 10, 2026 and lists Mark B Petersen, President, as its authorized official.

NPPES Registry Identity

NPI1841460029
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NamePETERSEN HEALTH SYSTEMS, INC.
Location Address1200 W BROADWAYMonmouth, IL 61462-1679
Mailing Address830 W Trailcreek DrPeoria, IL 61614-1862
Phone(309) 734-0909
Organization SubpartNo
Authorized OfficialMark B PetersenPresident · (309) 691-8113
Enumeration DateMarch 4, 2008
Last NPPES UpdateApril 20, 2008
✔ NPI 1841460029 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
1200 W BROADWAY, Monmouth, IL 61462
Open in Google Maps ↗

Other Names 1

Doing Business AsLegacy Estates Of Monmouth

Other Identifiers 2

Medicaid=========001IL
Medicaid=========801IL

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 14D2192582

Legacy Estates Of Monmouth · Monmouth, IL
Active · expires Sep 10, 2026
CLIA Number14D2192582
Laboratory TypeAssisted Living Facility
Certificate Effective DateSeptember 11, 2024
Certificate Expiration DateSeptember 10, 2026
Laboratory DirectorDanielle Blackett
Laboratory Phone(309) 734-0909
Laboratory LocationLegacy Estates Of Monmouth1200 W Broadway, Monmouth, IL 61462
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

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

HIGH POINT RESIDENCE MONMOUTH
Assisted Living Facility
1200 W BROADWAY
MONMOUTH, IL 61462
Warren County (847) 676-1700

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 Systems, Inc.'s NPI number?

The NPI number for Petersen Health Systems, Inc. is 1841460029. It was assigned to this organization in the NPPES registry on March 4, 2008. The provider is doing business as Legacy Estates Of Monmouth.

Where is Petersen Health Systems, Inc. located?

Petersen Health Systems, Inc. is located at 1200 W Broadway, Monmouth, IL 61462. The listed phone number is (309) 734-0909.

What is Petersen Health Systems, Inc.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Petersen Health Systems, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2192582) is associated with this NPI, valid through September 10, 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 Systems, Inc. was last updated on April 20, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.