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Contact Information

ILLINOIS MENTOR
4503 W DEYOUNG ST
SUITE 203C
MARION, IL62959-7654
 Phone: 618-997-9470
 Fax: 618-997-9478
 Website:
Indicates primary specialty

NPI Profile & details for ILLINOIS MENTOR

NPI Number 1598093767
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 11/30/2009 - About 17 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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