Provider Demographics
NPI:1104961747
Name:OHIO MENTOR, INC
Entity type:Organization
Organization Name:OHIO MENTOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE ACCOUNTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-864-5895
Mailing Address - Street 1:6200 ROCKSIDE WOODS BLVD N STE 305
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2343
Mailing Address - Country:US
Mailing Address - Phone:216-525-1885
Mailing Address - Fax:216-525-1894
Practice Address - Street 1:791 WHITE POND DR
Practice Address - Street 2:SUITE B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4202
Practice Address - Country:US
Practice Address - Phone:330-846-5895
Practice Address - Fax:330-864-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0528251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12176Medicare UPIN