Organization
NATIONAL MENTOR HEALTHCARE, LLC
Active
Other names
Indiana Mentor Adult Foster Care
Organization subpart
No
Provider details
NPI number
Authorized official
DAN MOHNKE (STATE DIRECTOR)
(317) 581-2380
Entity
Organization
Contact information
Practice address
1057 E JOHNSON RD, SOUTH BEND, IN 46614-5493
(317) 581-2380
Mailing address
8925 N MERIDIAN ST, SUITE 200, INDIANAPOLIS, IN 46260-2386
(317) 581-2380
(317) 581-2378
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200943350G
PROVIDER NUMBER
IN
Enumeration date
10/08/2010
Last updated
10/08/2010
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