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Contact Information

ILLINOIS MENTOR
4507 N STERLING AVE
PEORIA, IL61615-3824
 Phone: 309-676-6131
 Fax: 309-676-5655
 Website:
Indicates primary specialty

NPI Profile & details for ILLINOIS MENTOR

NPI # 1104154277
LBN Legal business name ILLINOIS MENTOR
Authorized official VIVIANE NGWA - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart 1 Yes
Enumeration date 11/30/2009
Last updated 12/03/2010 - About 16 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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