Organization
NJ MENTOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT IAN COHEN (COO)
(800) 388-5150
Entity
Organization
Contact information
Practice address
80 COTTONTAIL LN, SUITE 330, SOMERSET, NJ 08873-1100
(732) 627-9890
(732) 627-8412
Mailing address
80 COTTONTAIL LN, SUITE 330, SOMERSET, NJ 08873-1100
(732) 627-9890
(732) 627-8412
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5585805
—
NJ
Enumeration date
06/04/2008
Last updated
03/04/2023
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