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
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