Peoria Site 014030

LBN: Illinois Mentor
Peoria Site 014030 is an health care organization with primary practice located at 4507 N Sterling Ave , Peoria IL 61615-3824. The organization recently has 3 registered licenses in different health care specialties including Agencies / Case Management, Agencies / Foster Care Agency, Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities. Agencies / Foster Care Agency is the primary health care specialty. Illinois Mentor can be contacted via phone (309) 676-6131, or through Ngwa, Viviane via phone (708) 679-9137.

Contact Information

Primary practice address
4507 N Sterling Ave Peoria IL 61615-3824
Phone: (309) 676-6131
Fax: (309) 676-5655
Website:
Map and Directions
Authorized official contact:
Name: Ngwa, Viviane MSW
Phone: (708) 679-9137

Health care specialties

SpecialtyCodeLicense #State
Agencies / Case Management 251B00000X
Agencies / Foster Care Agency 253J00000X
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X

Profile Details

NPI number 1104154277
LBN Legal business name Illinois Mentor
DBA Doing business as Peoria Site 014030
Authorized official Ngwa, Viviane MSW
Entity Organization
Organization subpart 1 Yes
Enumeration date Nov 30th, 2009
Last updated Dec 3rd, 2010 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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