Healthcare Provider Details

I. General information

NPI: 1033862743
Provider Name (Legal Business Name): GREATER PEORIA SPECIALTY HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W ROMEO B GARRETT AVE
PEORIA IL
61605-2301
US

IV. Provider business mailing address

124 SW ADAMS ST
PEORIA IL
61602-1308
US

V. Phone/Fax

Practice location:
  • Phone: 309-680-1500
  • Fax:
Mailing address:
  • Phone: 309-655-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: KIRSTEN M LARGENT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 309-655-2850