Peoria Treatment Center, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

PEORIA TREATMENT CENTER, LLC

Doing business as

MedMark Treatment Centers East Peoria

Practice address

731 Sabrina Dr Unit C
East Peoria, IL 61611-3582

Phone

(877) 592-5901

Fax

(402) 592-5901

NPI assigned

Dec 9, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce Jarvie

Title

VP, Treasurer

Phone

(214) 379-3300

Specialties & licenses 1

Addresses

Other names 1

• MedMark Treatment Centers East Peoria Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Opioid treatment program

Medicare-enrolled since Jun 27, 2023

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Kay Huber, BS, CADC

  • Addiction (Substance Use Disorder) Counselor
  • East Peoria, IL
  • NPI 1437801271
  NPD
• Audrey Lynn Tanksley, MD

  • Internal Medicine Physician
  • Evergreen Park, IL
  • NPI 1750524518
  NPD
• Aneta M Byrd, LPN

  • Licensed Practical Nurse
  • East Peoria, IL
  • NPI 1508573528
  NPD (past)
• Patheresa A McCamy, LPN

  • Licensed Practical Nurse
  • East Peoria, IL
  • NPI 1679225940
  NPD (past)
• Christina McGrew, APN

  • Nurse Practitioner
  • Peoria, IL
  • NPI 1477274991
  NPD (past)
• Briana Nesbit, LPN

  • Licensed Practical Nurse
  • East Peoria, IL
  • NPI 1134871403
  NPD (past)
• Nicole J Reese, BSW

  • Addiction (Substance Use Disorder) Counselor
  • East Peoria, IL
  • NPI 1619621281
  NPD (past)
• Elena Maria Rickard, CADC

  • Addiction (Substance Use Disorder) Counselor
  • East Peoria, IL
  • NPI 1487305736
  NPD (past)
• Israel P Serrano, BS CADC MISA

  • Addiction (Substance Use Disorder) Counselor
  • East Peoria, IL
  • NPI 1124770235
  NPD (past)
• Christopher Walker, BA

  • Addiction (Substance Use Disorder) Counselor
  • East Peoria, IL
  • NPI 1699427443
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787270400000",
    "number": "1073944567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LAKEPOINTE DR STE 117",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576425",
            "telephone_number": "214-379-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 SABRINA DR UNIT C",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616113582",
            "telephone_number": "877-592-5901",
            "fax_number": "402-592-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA TREATMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "status": "A",
        "authorized_official_last_name": "JARVIE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "VP, TREASURER",
        "authorized_official_telephone_number": "214-379-3300"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MedMark Treatment Centers East Peoria",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jayme Sue Nowell, PHARMD
• Skye BF Ortman
• Osf Multi-Specialty Group (OSF OnCall Urgent Care)
• Farzeen Patel, RPH
• Kyle Pearson, LCPC, NCC, CADC
• Julie Perino
• Petersen Health Operations (Fondulac Rehabilitation & Health Care Center)
• Petersen Health Operations, LLC (Fondulac Rehabilitation & Health Care Center)
• Steven Petri
• Taylor Pham

• Adult Mental Health Clinic/Center in East Peoria, IL
• Providers in East Peoria, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.