Healthcare Provider Details

I. General information

NPI: 1609224203
Provider Name (Legal Business Name): MENTOR ABI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 BEVERLY RD SW
CEDAR RAPIDS IA
52404-7114
US

IV. Provider business mailing address

306 W MILL ST
CARBONDALE IL
62901-2727
US

V. Phone/Fax

Practice location:
  • Phone: 540-577-2511
  • Fax:
Mailing address:
  • Phone: 618-529-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

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