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Illinois Mentor — NPI 1326376591, O Fallon, IL | NPI Central

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NPI 1326376591

OrganizationActive

Illinois Mentor

NPI 1326376591 · Foster Care Agency · O Fallon, IL

Provider details

NPI number: 1326376591
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

791 Wall St

O Fallon, IL 62269-1959

Phone: (618) 628-9424

Fax: (618) 628-9426

Approximate (ZIP-level) locationGet directions

More IL providers

Mailing address

791 Wall St

O Fallon, IL 62269-1959

Other names (DBA / former)

Doing business as: O'Fallon Site 014010

Registry dates

Enumerated: 2009-11-30
Last updated: 2009-11-30

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