# NATIONAL MENTOR HEALTHCARE,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720141542
- **Authorized official:** BRETT IAN COHEN (COO)
- **Authorized official phone:** (800) 388-5150

## Contact information

- **Practice address:** 3615 HODGES BLVD, JACKSONVILLE, FL 32224-1288
- **Practice address phone:** (904) 223-4173
- **Practice address fax:** (904) 223-5611
- **Mailing address:** 3615 HODGES BLVD, JACKSONVILLE, FL 32224-1288
- **Mailing address phone:** (904) 223-4173
- **Mailing address fax:** (904) 223-5611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 4034096 | FL | Yes |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 03/19/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0312592 00 | — | FL |