Healthcare Provider Details

I. General information

NPI: 1407719131
Provider Name (Legal Business Name): I2 HEALTH OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9014 N WOOD SAGE ROAD
PEORIA IL
61615
US

IV. Provider business mailing address

32 E 57TH ST FL 17
NEW YORK NY
10022-8564
US

V. Phone/Fax

Practice location:
  • Phone: 844-360-8600
  • Fax:
Mailing address:
  • Phone: 212-243-5565
  • Fax: 212-243-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD KRESCH
Title or Position: MANAGER
Credential: MD
Phone: 212-243-5565