Organization
ILLINOIS MENTOR
Active
Parent organization
ILLINOIS MENTOR
Other names
Rockford Site 014025
Organization subpart
Yes
Provider details
NPI number
Legal business name
ILLINOIS MENTOR
Authorized official
VIVIANE NGWA MSW (EXECUTIVE DIRECTOR)
(708) 679-9137
Entity
Organization
Contact information
Practice address
6701 CLINTON RD, LOVES PARK, IL 61111-3863
(815) 282-6153
(815) 282-7160
Mailing address
6701 CLINTON RD, LOVES PARK, IL 61111-3863
(815) 282-6153
(815) 282-7160
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
253J00000X
Foster Care Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
11/30/2009
Last updated
11/30/2009
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us