Organization
NATIONAL MENTOR HEALTHCARE LLC
Active
Other names
New Jersey Mentor PRIDE RTC House
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT IAN COHEN (COO)
(800) 388-5150
Entity
Organization
Contact information
Practice address
80 COTTONTAIL LN, SUITE 330, SOMERSET, NJ 08873-1100
(732) 627-9890
(732) 563-6780
Mailing address
80 COTTONTAIL LN, SUITE 330, SOMERSET, NJ 08873-1100
(732) 627-9890
(732) 563-6780
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0472042
—
NJ
05
—
0485136
—
NJ
Enumeration date
01/09/2015
Last updated
03/12/2023
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