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NPI Code Detail

MEDICARE: EAST PEORIA NH LLC

MEDICARE: EAST PEORIA NH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care Facility

General Provider Information

NPI Number : 1114460839
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST PEORIA NH LLC
Provider Business Mailing Address
First Line : 900 CENTENNIAL DR
Second Line :
City : EAST PEORIA
State : IL
Zip : 61611-4928
Country : US
Telephone Number : 309-699-5400
Fax Number : 309-699-1632
Provider Business Practice Location Address
First Line : 900 CENTENNIAL DR
Second Line :
City : EAST PEORIA
State : IL
Zip : 61611-4928
Country : US
Telephone Number : 309-699-5400
Fax Number : 309-699-1632
Authorized Official
Title or Position : PRESIDENT
Name : JAMES MASON
Credential :
Telephone Number : 813-347-7425
Provider Enumeration Date : 11/29/2016
Last Update Date : 06/25/2021

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Directions to “EAST PEORIA NH LLC ” Practice Location

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