NPI 1386277556

Sullivan Hco, LLC

Organisation Skilled Nursing Facility Sullivan, IL

Practice location

Address: 11 Hawthorne Ln, Sullivan, IL 61951-9490
Phone: (217) 728-4327
Mailing address: 830 W Trailcreek Dr, Peoria, IL 61614-1862

Authorised official

Name: Mark B. Petersen
Title: Manager
Phone: (309) 691-8113

Registered specialties

Skilled Nursing Facility Primary

Nursing & Custodial Care Facilities Taxonomy 314000000X

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Registry record

NPI: 1386277556
Entity type: Organization
NPI issued: 17 Feb 2020
Record last updated: 17 Feb 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.