Healthcare Provider Details

I. General information

NPI: 1598413874
Provider Name (Legal Business Name): B AND K ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WALNUT ST
PEORIA IL
61602-1552
US

IV. Provider business mailing address

100 WALNUT ST APT 403
PEORIA IL
61602-1533
US

V. Phone/Fax

Practice location:
  • Phone: 630-776-2067
  • Fax:
Mailing address:
  • Phone: 630-776-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN A BRAGGS
Title or Position: OWNER/PRESIDENT
Credential: NA
Phone: 630-776-2067