Healthcare Provider Details

I. General information

NPI: 1245342591
Provider Name (Legal Business Name): MENTOR ABI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 HIGHWAY 298
BENTON AR
72019-9282
US

IV. Provider business mailing address

280 MERRIMACK ST STE 600
LAWRENCE MA
01843-1779
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-8799
  • Fax: 501-753-8204
Mailing address:
  • Phone: 501-758-8799
  • Fax: 501-753-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number10042
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number001
License Number StateAR

VIII. Authorized Official

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