Organization
ILLINOIS MENTOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA SPENCER (EXECUTIVE DIRECTOR)
17086799137
Entity
Organization
Contact information
Practice address
7 BRONZE POINTE S, SUITE B, SWANSEA, IL 62226-8308
(161) 823-4627
Mailing address
600 HOLIDAY PLAZA DR, SUITE 400, MATTESON, IL 60443-2241
(170) 867-9913
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
11/04/2013
Last updated
11/04/2013
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