ILLINOIS MENTOR (NPI# 1376871442) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376871442 |
| Entity Type | Organization |
| Organization Name | ILLINOIS MENTOR |
| Other Organization Name | QUINCY SITE 014075 |
| Practice Address |
522 Vermont St Suite 3 Quincy IL 62301-2926 |
| Practice Telephone | 2172245550 |
| Practice Fax Number | 2172245664 |
| Mailing Telephone | 2172245550 |
| Mailing Fax Number | 2172245664 |
| 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 |
|---|---|
| Quincy Site 014075 | 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 |
| 1326376591 | Illinois Mentor | Case Management | 791 Wall St, O Fallon, IL 62269-1959 | 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 |
522 VERMONT ST SUITE 3 |
| City | QUINCY |
| State | IL |
| Zip Code | 62301-2926 |
| 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 |
| 1134749716 | Bethany Nicole Jumps | Pharmacist | Broadway St & N 11th St, Quincy, IL 62301 | 2020-04-23 |
| 1043844293 | S.crider Construction An Supply Corp. | Contractor | 529 Woodbridge Dr., Quincy, IL 62301 | 2020-02-26 |
| 1245862002 | Quincy Physicians & Surgeons Clinic, Sc | Clinic/Center | 3301 Broadway St., Quincy, IL 62301 | 2020-02-10 |
| 1043851488 | West Central Illinois Nutrition | In Home Supportive Care | 639 York St. Room 333, Quincy, IL 62301 | 2019-10-07 |
| 1861986549 | Quincy Physicians & Surgeons Clinic, Sc | Internal Medicine | 3347 Broadway St, Quincy, IL 62301 | 2018-06-18 |
| 1194255083 | Michael Andrew Behrens | Nurse Practitioner | Broadway and 11th Street, Quincy, IL 62301 | 2017-06-14 |
| 1770987323 | Kirsty Yvonne Reed | Counselor | 205 S. 24th Street, Chaddock, Quincy, IL 62301 | 2014-10-10 |
| 1114234499 | Dale D. Shahan Dds Ltd | Dentist | 636 Hampshire Suite 102, Quincy, IL 62301 | 2010-09-08 |
| 1730314071 | James D Kaufmann | Pharmacist | 14th & Broadway, Quincy, IL 62301 | 2009-05-15 |
| Find all providers in zip 62301 | ||||
| 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 |
| 1467978742 | Stonewell Care LLC | Foster Care Agency | 859 Willard St Unit 4, Quincy, MA 02169-7482 | 2017-08-17 |
| 1720407471 | Neighborhood Healthcare LLC | Foster Care Agency | 1266 Furnace Brook Pkwy Ste 403, Quincy, MA 02169-4785 | 2014-04-09 |
| 1093063208 | Chaddock | Foster Care Agency | 921 N 24th St, Quincy, IL 62301-2267 | 2012-08-17 |
| 1891241634 | Environmental Alternatives | Foster Care Agency | 455 Main St, Quincy, CA 95971-9120 | 2016-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1902203540 | Lutheran Child and Family Services of Illinois | Foster Care Agency | 150 N Schuyler Ave, Suites 200-202, Second Floor, Kankakee, IL 60901-3839 | 2014-11-25 |
| Find all providers with the same taxonomy | ||||
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| 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.