ILLINOIS MENTOR (NPI# 1396073565) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396073565 |
| Entity Type | Organization |
| Organization Name | ILLINOIS MENTOR |
| Other Organization Name | ROCKFORD SITE 014025 |
| Practice Address |
6701 Clinton Rd Loves Park IL 61111-3863 |
| Practice Telephone | 8152826153 |
| Practice Fax Number | 8152827160 |
| Mailing Telephone | 8152826153 |
| Mailing Fax Number | 8152827160 |
| 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 |
|---|---|
| Rockford Site 014025 | 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 |
| 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 |
| 1104154277 | Illinois Mentor | Case Management | 4507 N Sterling Ave, Peoria, IL 61615-3824 | 2009-11-30 |
| Street Address |
6701 CLINTON RD |
| City | LOVES PARK |
| State | IL |
| Zip Code | 61111-3863 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477881142 | Jinglam Lai | Marriage & Family Therapist | 6701 Clinton Rd, Loves Park, IL 61111-3863 | 2009-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316562788 | Salli Jacobsen | Technician | 6699 Torch Lite Tr, Loves Park, IL 61111 | 2020-06-11 |
| 1003476425 | Costco Wholesale Corporation | Pharmacy | 5000 Stadium Drive, Loves Park, IL 61111 | 2019-06-18 |
| 1427541077 | Ronit Golan | Physical Therapist | 4401 Peak Dr Ste 1, Loves Park, IL 61111 | 2018-06-08 |
| 1598049025 | Sara Debelak | Developmental Therapist | 7225 Golden Eagle Drive, Loves Park, IL 61111 | 2011-10-03 |
| 1083906382 | Gagandeep Goyal | Anesthesiology | 5504 N 2nd St, Loves Park, IL 61111 | 2011-05-05 |
| 1124354261 | Asap Transport, LLC | Taxi | 7117 Clinton Rd, Suite 4, Loves Park, IL 61111 | 2009-10-25 |
| 1235212275 | Roger H Hill | Optometrist | 4301 N Mulford Rd, Loves Park, IL 61111 | 2006-10-23 |
| 1831104546 | Pointcore, Inc. | Pharmacy | 9951 Rock Cut Crossing, Loves Park, IL 61111 | 2006-07-30 |
| 1629099627 | Lisa A. Breisch | Counselor | Harmony Center for Holistic Psychotherapy, 6625 N. 2nd Street, Loves Park, IL 61111 | 2006-07-22 |
| 1386670529 | Joseph L Digirolamo | Chiropractor | 116 East Riverside Blvd, Loves Park, IL 61111 | 2006-06-22 |
| Find all providers in zip 61111 | ||||
| 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 | ||||
| City | LOVES PARK |
| Zip Code | 61111 |
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.