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Illinois Mentor — NPI 1104154277, Peoria, IL | NPI Central

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NPI 1104154277

OrganizationActive

Illinois Mentor

NPI 1104154277 · Foster Care Agency · Peoria, IL

Provider details

NPI number: 1104154277
Entity type: Organization
Primary specialty: Foster Care AgencyAgencies
Parent organization: Illinois Mentor
Organization subpart: Yes
Authorized official: Viviane Ngwa, Executive Director(708) 679-9137

Specialties & taxonomies

Foster Care AgencyPrimary253J00000X
Agencies
Case Management Agency251B00000X
Agencies
Intellectual and/or Developmental Disabilities Residential Treatment Facility320600000X
Residential Treatment Facilities

Practice location

4507 N Sterling Ave

Peoria, IL 61615-3824

Phone: (309) 676-6131

Fax: (309) 676-5655

Approximate (ZIP-level) locationGet directions

More IL providers

Mailing address

4507 N Sterling Ave

Peoria, IL 61615-3824

Other names (DBA / former)

Doing business as: Peoria Site 014030

Registry dates

Enumerated: 2009-11-30
Last updated: 2010-12-03

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.