NPI 1417913583

Sullivan Hco, LLC

Organisation Skilled Nursing Facility Sullivan, IL

Practice location

Address: 11 Hawthorne Ln, Sullivan, IL 61951-9490
Phone: (217) 728-4327
Fax: (217) 728-2263
Mailing address: 830 W Trailcreek Dr, Peoria, IL 61614-1862

Authorised official

Name: Mark B. Petersen
Title: Manager
Phone: (309) 689-5880

Registered specialties

Skilled Nursing Facility Primary

Nursing & Custodial Care Facilities Taxonomy 314000000X Licence 0046425 (IL)

Other Skilled Nursing Facility providers in Illinois →

Registry record

NPI: 1417913583
Entity type: Organization
NPI issued: 26 Apr 2006
Record last updated: 24 Sep 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.