Illinois Mentor
Illinois Mentor is a Case Management Agency in O Fallon, Illinois. Registered with an NPI since 2009.
- In the registry since
- 2009
- Specialties on file
- 3
Practice location Address checks out
791 Wall StO Fallon, IL 62269-1959
Phone: (618) 628-9424
Fax: (618) 628-9426
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Foster Care Agency (primary) | Taxonomy 253J00000X |
|---|---|
| Case Management Agency | Taxonomy 251B00000X |
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | Taxonomy 320600000X |
Record details
| NPI number | 1326376591 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | Yes |
| Parent organization | Illinois Mentor |
| Authorized official | Viviane Ngwa — Executive Director · (708) 679-9137 |
| Other names | O'Fallon Site 014010 |
| NPI enumerated | November 30, 2009 |
| Last updated in NPPES | November 30, 2009 |
| Mailing address | 791 Wall St, O Fallon, IL 62269-1959 |