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Organization
MENTOR ABI
Active
Organization
MENTOR ABI
Active
Other names
NeuroRestorative Pennsylvania
Organization subpart
No
Provider details
NPI number
Authorized official
SERGIO P CRUZ (CFO)
(781) 708-9444
Entity
Organization
Contact information
Practice address
6816 W LAKE RD, FAIRVIEW, PA 16415-1645
(813) 626-1444
(813) 621-0770
Mailing address
980 WASHINGTON ST STE 306, DEDHAM, MA 02026-6797
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
NULL
311ZA0620X
Adult Care Home Facility
—
NULL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
NULL
Other
Enumeration date
03/25/2010
Last updated
09/25/2022
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