Organization
NATIONAL MENTOR HOLDINGS INC
Active
Other names
Illinois MENTOR Community Services LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID HAUTANEN (BUSINESS DIRECTOR)
(608) 276-1194
Entity
Organization
Contact information
Practice address
600 HOLIDAY PLAZA DR, SUITE 400, MATTESON, IL 60443-2241
(708) 679-9137
(708) 503-6267
Mailing address
2005 W BELTLINE HWY, SUITE 203, MADISON, WI 53713-2314
(608) 276-1191
(608) 276-1184
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
461224998
—
IL
Enumeration date
05/30/2013
Last updated
06/27/2013
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