Provider Demographics
NPI:1386879096
Name:MENTOR ABI, LLC
Entity type:Organization
Organization Name:MENTOR ABI, LLC
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:MBA
Authorized Official - Phone:800-388-5150
Mailing Address - Street 1:639 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5366
Mailing Address - Country:US
Mailing Address - Phone:781-356-6330
Mailing Address - Fax:
Practice Address - Street 1:6 KING RD
Practice Address - Street 2:
Practice Address - City:CHICHESTER
Practice Address - State:NH
Practice Address - Zip Code:03258-6533
Practice Address - Country:US
Practice Address - Phone:603-798-3376
Practice Address - Fax:603-798-3748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No283X00000XHospitalsRehabilitation Hospital
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME143240001Medicaid
ME143240000Medicaid