Provider Demographics
NPI:1982406484
Name:MENTIS ADULT SERVICES LLC
Entity type:Organization
Organization Name:MENTIS ADULT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DJEMS
Authorized Official - Middle Name:MBANZA
Authorized Official - Last Name:KWEMBE
Authorized Official - Suffix:
Authorized Official - Credentials:BED
Authorized Official - Phone:603-820-3216
Mailing Address - Street 1:463 BEECH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-6295
Mailing Address - Country:US
Mailing Address - Phone:603-506-7437
Mailing Address - Fax:
Practice Address - Street 1:463 BEECH ST APT 1
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-6295
Practice Address - Country:US
Practice Address - Phone:603-506-7437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities