Active NPI
Proctor Community Hospital
- Skilled Nursing Facility
- Peoria, IL
National Provider Identifier
1821068404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 0001925
- Legal business name
- PROCTOR COMMUNITY HOSPITAL
- Practice address
- 5409 N Knoxville Ave
Peoria, IL 61614-5016 - Phone
- (309) 691-1000
- Fax
- (309) 671-8265
- NPI assigned
- Jan 25, 2006
- Organization subpart
- Yes
- Parent organization
- PROCTOR COMMUNITY HOSPITAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Deborah R. Simon
- Title
- President/Ceo
- Phone
- (309) 672-5928
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1677264 | IL | |
| Skilled Nursing Facility | 314000000X | 0001925 | IL | Primary |
Addresses
Primary practice location
5409 N Knoxville Ave
Peoria, IL 61614-5016
Mailing address
5409 N Knoxville Ave
Peoria, IL 61614-5016
Phone (309) 672-4813
Other names 1
- Proctor Hospital Skilled Nursing
National Provider Directory
National Provider Directory- Part of
- Belcrest LTD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138147200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1421971200000",
"number": "1821068404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5409 N KNOXVILLE AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145016",
"telephone_number": "309-672-4813",
"fax_number": "309-671-8265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5409 N KNOXVILLE AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145016",
"telephone_number": "309-691-1000",
"fax_number": "309-671-8265"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROCTOR COMMUNITY HOSPITAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PROCTOR COMMUNITY HOSPITAL",
"enumeration_date": "2006-01-25",
"last_updated": "2015-01-23",
"status": "A",
"authorized_official_last_name": "SIMON",
"authorized_official_first_name": "DEBORAH",
"authorized_official_middle_name": "R.",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "309-672-5928",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IL",
"license": "1677264",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IL",
"license": "0001925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Proctor Hospital Skilled Nursing",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.