MEDICARE: ARCOLA HCO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0046045	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437115417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCOLA HCO, LLC

Provider Business Mailing Address
First Line	:	830 W TRAILCREEK DR
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-1862
Country	:	US
Telephone Number	:	309-691-8113
Fax Number	:	309-691-8622

Provider Business Practice Location Address
First Line	:	422 E 4TH SOUTH STREET
Second Line	:
City	:	ARCOLA
State	:	IL
Zip	:	61910
Country	:	US
Telephone Number	:	217-268-3022
Fax Number	:	217-268-4180

Authorized Official
Title or Position	:	MANAGER
Name	:	MARK B. PETERSEN
Credential	:
Telephone Number	:	309-689-5880

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	10/19/2020

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