NPIMap

Organization Active NPI

Illinois Mentor

Doing business as Rockford Site 014025

  • Foster Care Agency
  • Loves Park, IL
National Provider Identifier
1396073565
Registry record updated Nov 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foster Care AgencyTaxonomy code 253J00000X
Legal business name
ILLINOIS MENTOR
Doing business as
Rockford Site 014025
Practice address
6701 Clinton Rd
Loves Park, IL 61111-3863
Phone
(815) 282-6153
Fax
(815) 282-7160
NPI assigned
Nov 30, 2009
Last updated
Nov 30, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
ILLINOIS MENTORAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2009

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

Authorized official

Name
Viviane Ngwa, MSW
Title
Executive Director
Phone
(708) 679-9137

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Foster Care Agency 253J00000X Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X

Addresses

Primary practice location

6701 Clinton Rd
Loves Park, IL 61111-3863

Mailing address

6701 Clinton Rd
Loves Park, IL 61111-3863
Phone (815) 282-6153

Other names 1

  • Rockford Site 014025 Doing business as

National Provider Directory

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

Other organizations with this tax ID 7

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

Locations

6701 Clinton Rd
Loves Park, IL 61111
Phone (815) 282-6153

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1259539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259539200000",
    "number": "1396073565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 CLINTON RD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611113863",
            "telephone_number": "815-282-6153",
            "fax_number": "815-282-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 CLINTON RD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611113863",
            "telephone_number": "815-282-6153",
            "fax_number": "815-282-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS MENTOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ILLINOIS MENTOR",
        "enumeration_date": "2009-11-30",
        "last_updated": "2009-11-30",
        "status": "A",
        "authorized_official_last_name": "NGWA",
        "authorized_official_first_name": "VIVIANE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-679-9137",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rockford Site 014025",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loves Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; 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.