Basic Information
| Provider Information | |||||||||
| NPI: | 1033862743 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER PEORIA SPECIALTY HOSPITAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W ROMEO B GARRETT AVE | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616052301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096801500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 W ROMEO B GARRETT AVE | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616052301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096801500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2022 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | TEAGUE | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, CORPORATE SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6292535121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | Y | Hospital Units | Rehabilitation Unit |
No ID Information.