Healthcare Provider Details

I. General information

NPI: 1588937486
Provider Name (Legal Business Name): NATIONAL MENTOR HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28417 DUPONT HIGHWAY
MILLSBORO DE
19966-1209
US

IV. Provider business mailing address

230 MITCHELL ST STE A
MILLSBORO DE
19966-9402
US

V. Phone/Fax

Practice location:
  • Phone: 732-627-9890
  • Fax: 732-563-6780
Mailing address:
  • Phone: 302-934-0512
  • Fax: 302-934-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: PHIL KAUFMAN
Title or Position: CEO
Credential:
Phone: 800-388-5150