Organization
ILLINOIS MENTOR COMMUNITY SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY HANSEN-BLAKE (EXECUTIVE DIRECTOR)
(608) 427-5945
Entity
Organization
Contact information
Practice address
20646 ABBEY WOODS CT N, SUITE 201, FRANKFORT, IL 60423-3161
(815) 464-3239
Mailing address
20646 ABBEY WOODS CT N, SUITE 201, FRANKFORT, IL 60423-3161
(815) 464-3239
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
19910008
IL
Other
Enumeration date
05/06/2016
Last updated
05/06/2016
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