Provider Demographics
NPI:1588104574
Name:OHIO MENTOR, INC.
Entity type:Organization
Organization Name:OHIO MENTOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:BONSUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-957-2735
Mailing Address - Street 1:5655 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3948
Mailing Address - Country:US
Mailing Address - Phone:614-885-0920
Mailing Address - Fax:
Practice Address - Street 1:5655 N HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3948
Practice Address - Country:US
Practice Address - Phone:614-885-0920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH010528253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency