# MENTOR ABI

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NeuroRestorative Pennsylvania
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922322502
- **Authorized official:** SERGIO P CRUZ (CFO)
- **Authorized official phone:** (781) 708-9444

## Contact information

- **Practice address:** 6816 W LAKE RD, FAIRVIEW, PA 16415-1645
- **Practice address phone:** (813) 626-1444
- **Practice address fax:** (813) 621-0770
- **Mailing address:** 980 WASHINGTON ST STE 306, DEDHAM, MA 02026-6797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | Yes |
| 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