NPI 1104154277

Illinois Mentor

Organisation Foster Care Agency Peoria, IL

Practice location

Address: 4507 N Sterling Ave, Peoria, IL 61615-3824
Phone: (309) 676-6131
Fax: (309) 676-5655

Authorised official

Name: Viviane Ngwa
Title: Executive Director
Phone: (708) 679-9137

Registered specialties (3)

Foster Care Agency Primary

Agencies Taxonomy 253J00000X

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Case Management Agency

Agencies Taxonomy 251B00000X

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Intellectual and/or Developmental Disabilities Residential Treatment Facility

Residential Treatment Facilities Taxonomy 320600000X

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Registry record

NPI: 1104154277
Entity type: Organization
NPI issued: 30 Nov 2009
Record last updated: 3 Dec 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.