MEDICARE: PEORIA ASSOCIATION FOR RETARDED CITIZENS INC

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
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1184887440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEORIA ASSOCIATION FOR RETARDED CITIZENS INC

Provider Business Mailing Address
First Line	:	1913 W TOWNLINE RD
Second Line	:	PO BOX 3418
City	:	PEORIA
State	:	IL
Zip	:	61615-1621
Country	:	US
Telephone Number	:	309-691-3800
Fax Number	:	309-689-3613

Provider Business Practice Location Address
First Line	:	4405 W LYONS CT
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-2808
Country	:	US
Telephone Number	:	309-691-3800
Fax Number	:	309-689-3613

Authorized Official
Title or Position	:	VP, ACCOUNTING
Name	:	CINDY FLETCHER
Credential	:
Telephone Number	:	309-691-3800

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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