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ILLINOIS MENTOR NPI 1598093767


NPI Information

NPI: 1598093767
Provider Name: ILLINOIS MENTOR

Doing Business As: MARION SITE 014015

Classification: Foster Care Agency - 253J00000X
Entity Type: Organization
Address:
4503 W DEYOUNG ST
SUITE 203C
MARION, IL
ZIP 62959
Phone: (618) 997-9470
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ILLINOIS MENTOR is a foster care agency in Marion, IL. The provider is a Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as 24-hour substitute care for children outside their own homes. Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes. ILLINOIS MENTOR NPI is 1598093767. The provider is registered as an organization entity type.
The provider Is Doing Business As Marion Site 014015.

The provider's business location address is:

4503 W DEYOUNG ST
SUITE 203C
MARION, IL
ZIP 62959-654
Phone: (618) 997-9470
Fax: (618) 997-9478

The provider's authorized official is Viviane Ngwa .
The authorized official title is Executive Director and has the following contact phone number (708) 679-9137.

The enumeration date for this NPI number is 11/30/2009 and was last updated on 11/30/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1251B00000XCase ManagementNo
2320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesNo
3253J00000XFoster Care AgencyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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