Healthcare Provider Details

I. General information

NPI: 1225281975
Provider Name (Legal Business Name): NATIONAL MENTOR HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SAMFORD AVE STE 30B
OPELIKA AL
36801-3146
US

IV. Provider business mailing address

6600 FRANCE AVE S STE 350
EDINA MN
55435-1810
US

V. Phone/Fax

Practice location:
  • Phone: 334-705-8877
  • Fax:
Mailing address:
  • Phone: 800-388-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number040905
License Number StateAL

VIII. Authorized Official

Name: MARY PATRICIA RODENBERG-ROBERTS
Title or Position: CHIEF REGULATORY OFFICER SR ASST GC
Credential:
Phone: 952-836-2234