MEDICARE: I2 HEALTH OPCO 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
1	283Q00000X	Psychiatric Hospital

General Provider Information

NPI Number	:	1407719131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I2 HEALTH OPCO LLC

Provider Business Mailing Address
First Line	:	32 E 57TH ST FL 17
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-8564
Country	:	US
Telephone Number	:	212-243-5565
Fax Number	:	212-243-1099

Provider Business Practice Location Address
First Line	:	9014 N WOOD SAGE ROAD
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615
Country	:	US
Telephone Number	:	844-360-8600
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. RICHARD KRESCH
Credential	:	MD
Telephone Number	:	212-243-5565

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “I2 HEALTH OPCO LLC ” Practice Location

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