Illinois Mentor

NPI 1104154277 - Case Management - 251B00000X

NPI Details
NPI 1104154277
Enumeration Date 11/30/2009
Last Updated 12/03/2010
Entity Type Healthcare Provider
Active Over 7 years ago
Authorized Information
Name VIVIANE VIVIANE
Position EXECUTIVE DIRECTOR
Phone (309) 676-6131
Fax (309) 676-5655
Practice Location
4507 N STERLING AVE
PEORIA IL, 61615-3824, US
Phone (309) 676-6131
Fax (309) 676-5655
Business Location
4507 N STERLING AVE
PEORIA IL, 61615-3824, US
Phone (309) 676-6131
Fax (309) 676-5655
Toxanomy
Taxonomy Code 251B00000X
License State
License Number
Remove 1104154277 NPI Number
 

According to our database, Illinois Mentor NPI is 1104154277, taxonomy code is 251B00000X Illinois Mentor physically located at 4507 N Sterling Ave, Peoria IL, 61615-3824. NPI Number 1033115704 has the healthcare provider type.

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1104154277 NPI number is provided on an as is basis without warranty of any kind. 1104154277 is maintained by the National Plan & Provider Enumeration System. The contents of Illinois Mentor are for informational purposes only.