MEDICARE: NATIONAL MENTOR HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	2271	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194881417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL MENTOR HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3838 N CENTRAL AVE STE 1200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1997
Country	:	US
Telephone Number	:	480-646-6175
Fax Number	:	617-790-4271

Provider Business Practice Location Address
First Line	:	1813 W CURRY DR
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-1209
Country	:	US
Telephone Number	:	480-777-2028
Fax Number	:

Authorized Official
Title or Position	:	VP & SR ASST GENERAL COUNSEL
Name	:	MARY PATRICIA RODENBERG-ROBERTS
Credential	:
Telephone Number	:	952-836-2234

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	08/21/2025

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