ILLINOIS MENTOR (NPI# 1326376591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326376591 |
| Entity Type | Organization |
| Organization Name | ILLINOIS MENTOR |
| Other Organization Name | O'FALLON SITE 014010 |
| Practice Address |
791 Wall St O Fallon IL 62269-1959 |
| Practice Telephone | 6186289424 |
| Practice Fax Number | 6186289426 |
| Mailing Telephone | 6186289424 |
| Mailing Fax Number | 6186289426 |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2009-11-30 |
| Authorized Official Name | VIVIANE NGWA (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7086799137 |
| Authorized Official Credential | MSW |
| Is Organization Subpart | Y |
| Parent Organization Name | ILLINOIS MENTOR |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251B00000X | Case Management | Agencies | ||
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| Y | 253J00000X | Foster Care Agency | Agencies |
| Other Name | Type Code |
|---|---|
| O'Fallon Site 014010 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366871063 | Illinois Mentor | Foster Care Agency | 7 Bronze Pointe S, Suite B, Swansea, IL 62226-8308 | 2013-11-04 |
| 1376871442 | Illinois Mentor | Case Management | 522 Vermont St, Suite 3, Quincy, IL 62301-2926 | 2009-11-30 |
| 1396954467 | Illinois Mentor | Case Management | 600 Holiday Plaza Dr, Suite 400, Matteson, IL 60443-2241 | 2007-05-22 |
| 1124457825 | Illinois Mentor | Foster Care Agency | 615 N Longwood St, Rockford, IL 61107-4265 | 2013-11-04 |
| 1598093767 | Illinois Mentor | Case Management | 4503 W Deyoung St, Suite 203c, Marion, IL 62959-7654 | 2009-11-30 |
| 1396073565 | Illinois Mentor | Case Management | 6701 Clinton Rd, Loves Park, IL 61111-3863 | 2009-11-30 |
| 1104154277 | Illinois Mentor | Case Management | 4507 N Sterling Ave, Peoria, IL 61615-3824 | 2009-11-30 |
| Street Address |
791 WALL ST |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-1959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 253J00000X |
| Grouping | Agencies |
| Classification | Foster Care Agency |
| A Foster Care Agency is an agency that provides foster care as defined in the Code of Federal Regulations (CFR) as "24-hour substitute care for children outside their own homes." Foster care settings include, but are not limited to, nonrelative foster family homes, relative foster homes (whether payments are being made or not), group homes, emergency shelters, residential facilities, and pre-adoptive homes. |
| Notes: Source: Code Of Federal Regulations, Title 45, Volume 4, Part 1355, Section 57 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356969471 | Lutheran Child and Family Service of Illinois | Foster Care Agency | 1400 N. 30th St, Quincy, IL 62301 | 2020-07-07 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1356885768 | Lutheran Child and Family Services | Foster Care Agency | 431 W Pershing Rd, Decatur, IL 62526-3275 | 2016-12-05 |
| 1578013918 | Lutheran Child and Family Services | Foster Care Agency | 400 S Grand Ave W, Springfield, IL 62704-3718 | 2016-10-10 |
| 1992152409 | Envision Unlimited Foster Care | Foster Care Agency | 1814 W 103rd St, Chicago, IL 60643-2817 | 2016-05-16 |
| 1700230976 | Camelot Care Centers, LLC. | Foster Care Agency | 34121 North Route 45, Suite 207, Grayslake, IL 60030 | 2016-04-14 |
| 1356704241 | Lutheran Child and Family Services of Illinois | Foster Care Agency | 329 W Lake St, Addison, IL 60101-2514 | 2016-03-30 |
| 1376900571 | Ucp Seguin Greater Chicago | Foster Care Agency | 7550 W. 183rd, Tinley Park, IL 60477 | 2016-01-20 |
| 1932598893 | Sos Children's Villages Illinois | Foster Care Agency | 1200 W Roosevelt Rd, Chicago, IL 60608-1414 | 2015-01-15 |
| 1164820460 | Lutheran Child and Family Service of Illinois | Foster Care Agency | 2175 Oneida St, Suite 200, Joliet, IL 60435-6560 | 2014-12-18 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on ILLINOIS MENTOR.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.