Organization
NATIONAL MENTOR HEALTHCARE, LLC
Active
Other names
Indiana MENTOR
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT IAN COHEN (COO)
(800) 388-5150
Entity
Organization
Contact information
Practice address
15 EXECUTIVE DR, STE 1, LAFAYETTE, IN 47905-3833
(317) 581-2380
Mailing address
313 CONGRESS ST, BOSTON, MA 02210-1218
(800) 388-5150
(617) 790-4271
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200943350J
PROVIDER NUMBER
IN
Enumeration date
09/29/2010
Last updated
03/05/2023
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