Provider Demographics
NPI:1316152622
Name:NATIONAL MENTOR HEALTHCARE INC
Entity type:Organization
Organization Name:NATIONAL MENTOR HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-388-5150
Mailing Address - Street 1:313 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-1218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7615 E 63RD PL
Practice Address - Street 2:THREE MEMORIAL PLACE, SUITE 130
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1244
Practice Address - Country:US
Practice Address - Phone:918-254-6748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK376J506251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100630280 KMedicaid
OK100630280 CMedicaid
OK100630280 BMedicaid
OK100630280 DMedicaid
OK100630280 FMedicaid
OK100630280 HMedicaid
OK100630280 AMedicaid
OK100630280 EMedicaid
OK100630280 GMedicaid
OK100630280 IMedicaid
OK100630280 JMedicaid