Provider Demographics
NPI:1336644368
Name:MENTIS
Entity type:Organization
Organization Name:MENTIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-255-0966
Mailing Address - Street 1:1272 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1711
Mailing Address - Country:US
Mailing Address - Phone:707-255-0966
Mailing Address - Fax:707-710-9511
Practice Address - Street 1:1272 HAYES ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1711
Practice Address - Country:US
Practice Address - Phone:707-255-0966
Practice Address - Fax:707-710-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health