Illinois Mentor in Matteson - Residential Treatment Facility, Intellectual And/or Developmental Disabilities
Illinois Mentor - NPI 1396954467
Illinois Mentor is a Residential Treatment Facility, Intellectual And/or Developmental Disabilities in Matteson, Illinois. Illinois Mentor practices all healthcare services and medical treatments related to Residential Treatment Facility, Intellectual And/or Developmental Disabilities. The NPI Number for Illinois Mentor is 1396954467. The last update date is 2022-07-21.
Illinois Mentor's current location address is 600 Holiday Plaza Dr, Matteson, Illinois. You can contact this provider via phone number 7086799137 and fax number 7085036267. The mailing address for Illinois Mentor is 600 Holiday Plaza Dr, Matteson, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Illinois Mentor |
|---|---|
| Address | 600 Holiday Plaza Dr, Matteson, Illinois |
| Phone Number | 7086799137 |
| Fax Number | 7085036267 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | EXECUTIVE |
|---|---|
| Authorized Official Name | Ngwa Viviane |
| Credentials | MSW |
| Telephone Number | 7086799137 |
NPI Number Detail
| NPI Number | 1396954467 |
|---|---|
| Provider Enumeration Date | 2007-05-22 |
| Last Updated Date | 2022-07-21 |
Provider Mailing Address Detail
| Address | 600 Holiday Plaza Dr |
|---|---|
| City | Matteson |
| State | Illinois (IL) |
| Post Code | 604432241 |
| Phone Number | 7086799137 |
| Fax Number | 7085036267 |
Provider's Primary Taxonomy Detail
| Speciality | Residential Treatment Facility, Intellectual And/or Developmental Disabilities |
|---|---|
| Taxonomy | 320600000X |
|
Definition: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. |
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What is the Illinois Mentor's 1396954467?
The Illinois Mentor's NPI (National Provider Identifier) Number is 1396954467. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Where is the Illinois Mentor located?
The Illinois Mentor is located at 600 Holiday Plaza Dr, Matteson, IL 604432241.
What is the Illinois Mentor's specialty and taxonomy code?
The Illinois Mentor's specialty is Residential Treatment Facility, Intellectual And/or Developmental Disabilities, and the corresponding taxonomy code is 320600000X.
On what date did the Centers for Medicare & Medicaid Services assign the 1396954467 to Illinois Mentor?
The Centers for Medicare & Medicaid Services assigned the 1396954467 to Illinois Mentor on 2007-05-22.
As of what date were the details related to Illinois Mentor most recently updated or revised?
The information pertaining to Illinois Mentor, including its address, specialty, and other relevant details, was last updated or revised on 2022-07-21.