Organization
NATIONAL MENTOR HEALTHCARE NETWORK
Active
Other names
Florida Mentor
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT IAN COHEN (COO)
(800) 388-5150
Entity
Organization
Contact information
Practice address
4550 RICKER RD, JACKSONVILLE, FL 32210-6308
(904) 778-0935
(904) 778-8396
Mailing address
313 CONGRESS ST, BOSTON, MA 02210-1218
(800) 388-5150
(617) 790-4271
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
4060096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018500800
—
FL
05
—
031258400
—
FL
Enumeration date
10/27/2006
Last updated
03/04/2023
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