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Organization

NATIONAL MENTOR HEALTHCARE,LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRETT IAN COHEN (COO)
(800) 388-5150
Entity
Organization

Contact information

Practice address
3615 HODGES BLVD, JACKSONVILLE, FL 32224-1288
(904) 223-4173
(904) 223-5611
Mailing address
3615 HODGES BLVD, JACKSONVILLE, FL 32224-1288
(904) 223-4173
(904) 223-5611

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
4034096
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0312592 00
FL
Enumeration date
12/19/2006
Last updated
03/19/2023
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