Healthcare Provider Details

I. General information

NPI: 1164099198
Provider Name (Legal Business Name): SOLVERA HEALTHCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 N UNIVERSITY ST
PEORIA IL
61604-1324
US

IV. Provider business mailing address

PO BOX 9727
PEORIA IL
61612-9727
US

V. Phone/Fax

Practice location:
  • Phone: 309-886-9172
  • Fax:
Mailing address:
  • Phone: 309-886-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICK CAPLIS
Title or Position: CEO
Credential:
Phone: 309-886-9172