Provider Demographics
NPI:1972667004
Name:NATIONAL MENTOR HEALTHCARE LLC
Entity type:Organization
Organization Name:NATIONAL MENTOR HEALTHCARE 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:
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:800-388-5150
Mailing Address - Fax:617-790-4271
Practice Address - Street 1:450 PARKWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4202
Practice Address - Country:US
Practice Address - Phone:610-353-5332
Practice Address - Fax:610-353-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X, 251S00000X, 261QM0801X
PA201400251S00000X
PA105910251S00000X
PA200940251S00000X
PA465190251S00000X
PA354900251S00000X
PA0013499739-0010251S00000X
PA201020251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)