MEDICARE: BEMENT 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

General Provider Information

NPI Number	:	1720611973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEMENT 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	:	309-689-5880
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 N MORGAN ST
Second Line	:
City	:	BEMENT
State	:	IL
Zip	:	61813-1046
Country	:	US
Telephone Number	:	217-678-2191
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARK B. PETERSEN
Credential	:
Telephone Number	:	309-691-8113

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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Directions to “BEMENT HCO, LLC ” Practice Location

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