Organization
NATIONAL MENTOR HEALTHCARE, LLC
Active
Other names
Arizona Mentor- Evergreen
Organization subpart
No
Provider details
NPI number
Authorized official
MARY PATRICIA RODENBERG-ROBERTS (VP & SR ASST GENERAL COUNSEL)
(952) 836-2234
Entity
Organization
Contact information
Practice address
3838 N CENTRAL AVE STE 1200, PHOENIX, AZ 85012-1997
(480) 646-6175
(602) 567-2062
Mailing address
3838 N CENTRAL AVE STE 1200, PHOENIX, AZ 85012-1997
(480) 646-6175
(602) 567-2062
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-3412
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
451471
—
AZ
Enumeration date
09/01/2009
Last updated
08/21/2025
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