Organization
NATIONAL MENTOR HEALTHCARE, LLC
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
111 NE CAPRONA AVE, PORT ST LUCIE, FL 34983-8450
(772) 879-1925
Mailing address
313 CONGRESS ST, BOSTON, MA 02210-1218
(800) 388-5150
(617) 790-4271
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
4017096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0312657
—
FL
Enumeration date
12/15/2006
Last updated
03/04/2023
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