NPIMap

Organization Active NPI

Illinois Mentor

  • Foster Care Agency
  • Rockford, IL
National Provider Identifier
1124457825
Registry record updated Nov 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foster Care AgencyTaxonomy code 253J00000X
Legal business name
ILLINOIS MENTOR
Practice address
615 N Longwood St
Rockford, IL 61107-4265
Phone
(181) 528-2615
NPI assigned
Nov 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sara Spencer
Title
Executive Director
Phone
(708) 679-9137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foster Care Agency 253J00000X Primary

Addresses

Primary practice location

615 N Longwood St
Rockford, IL 61107-4265

Mailing address

600 Holiday Plaza Dr
Suite 400
Matteson, IL 60443-2241
Phone (170) 867-9913

National Provider Directory

National Provider Directory
Tax ID family
Illinois Mentor8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

615 N Longwood St
Rockford, IL 61107

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383523200000",
    "number": "1124457825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 HOLIDAY PLAZA DR",
            "address_2": "SUITE 400",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432241",
            "telephone_number": "170-867-9913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N LONGWOOD ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611074265",
            "telephone_number": "181-528-2615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS MENTOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-04",
        "last_updated": "2013-11-04",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "17086799137"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.