Provider Demographics
NPI:1891241022
Name:PEORIA SLF LP
Entity Type:Organization
Organization Name:PEORIA SLF LP
Other - Org Name:GATEWAY AT RIVER CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF GARDANT MANAGEMENT SOL
Authorized Official - Prefix:
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEAVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-935-1992
Mailing Address - Street 1:518 WEST ROMEO B. GARRETT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605
Mailing Address - Country:US
Mailing Address - Phone:309-673-3115
Mailing Address - Fax:309-673-3117
Practice Address - Street 1:518 WEST ROMEO B. GARRETT AVENUE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605
Practice Address - Country:US
Practice Address - Phone:309-673-3115
Practice Address - Fax:309-673-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility