Healthcare Provider Details

I. General information

NPI: 1124130208
Provider Name (Legal Business Name): BELCREST SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 E WASHINGTON ST
EAST PEORIA IL
61611-1863
US

IV. Provider business mailing address

1120 E WAR MEMORIAL DR
PEORIA HEIGHTS IL
61616-7757
US

V. Phone/Fax

Practice location:
  • Phone: 309-694-6464
  • Fax: 309-694-6032
Mailing address:
  • Phone: 309-685-0100
  • Fax: 309-685-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD J BAKER
Title or Position: GENERAL MANAGER
Credential:
Phone: 309-685-0100