National Mentor Holdings Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

NATIONAL MENTOR HOLDINGS INC

Doing business as

Illinois MENTOR Community Services LLC

Practice address

600 Holiday Plaza Dr
Suite 400
Matteson, IL 60443-2241

Phone

(708) 679-9137

Fax

(708) 503-6267

NPI assigned

May 30, 2013

Organization subpart

No

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

Authorized official

Name

David Hautanen

Title

Business Director

Phone

(608) 276-1194

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Illinois MENTOR Community Services LLC Doing business as

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372291200000",
    "number": "1821435801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 W BELTLINE HWY",
            "address_2": "SUITE 203",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537132314",
            "telephone_number": "608-276-1191",
            "fax_number": "608-276-1184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 HOLIDAY PLAZA DR",
            "address_2": "SUITE 400",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432241",
            "telephone_number": "708-679-9137",
            "fax_number": "708-503-6267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL MENTOR HOLDINGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2013-06-27",
        "status": "A",
        "authorized_official_last_name": "HAUTANEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "608-276-1194"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "461224998",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Illinois MENTOR Community Services LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Matteson, IL
• Providers in Matteson, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.