Organization
MENTOR IDAHO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN E JACOME (SR. BUSINESS DIRECTOR)
(951) 201-5914
Entity
Organization
Contact information
Practice address
699 S OTTER AVE, MERIDIAN, ID 83642-6144
(951) 201-5914
Mailing address
9166 ANAHEIM PL STE 200, RANCHO CUCAMONGA, CA 91730-8547
(915) 201-5914
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
03/23/2021
Last updated
05/26/2021
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