NPI 1326376591

Illinois Mentor

Organisation Foster Care Agency O Fallon, IL

Practice location

Address: 791 Wall St, O Fallon, IL 62269-1959
Phone: (618) 628-9424
Fax: (618) 628-9426

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: 1326376591
Entity type: Organization
NPI issued: 30 Nov 2009
Record last updated: 30 Nov 2009

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.