Healthcare Provider Details

I. General information

NPI: 1699040584
Provider Name (Legal Business Name): MENTOR PLUS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114-A SOUTH COMMERCIAL CIR
WARNER ROBINS GA
31088
US

IV. Provider business mailing address

114-A SOUTH COMMERCIAL CIR
WARNER ROBINS GA
31088
US

V. Phone/Fax

Practice location:
  • Phone: 188-986-5646
  • Fax:
Mailing address:
  • Phone: 188-986-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. BRIAN GOODWIN HAMPTON JR.
Title or Position: CEO/ DIRECTOR OF OPERATIONS
Credential: MS
Phone: 888-986-5646