Organization
MENTOR IDAHO, LLC
Active
Organization
MENTOR IDAHO, LLC
Active
Other names
Mentor Idaho, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN E JACOME (SR. BUSINESS DIRECTOR)
(951) 201-5914
Entity
Organization
Contact information
Practice address
12553 W EXPLORER DR STE 190, BOISE, ID 83713-1612
(951) 201-5914
Mailing address
9166 ANAHEIM PLACE, SUIE 200, RANCHO CUCAMONGA, CA 91730
(951) 201-5914
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
05/27/2021
Last updated
05/27/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up