Healthcare Provider Details

I. General information

NPI: 1780242925
Provider Name (Legal Business Name): MENTOR ABI,LLC D/B/A NEURORESTORATIVE IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 C ST SW
CEDAR RAPIDS IA
52404-3753
US

IV. Provider business mailing address

2340 C ST SW
CEDAR RAPIDS IA
52404-3753
US

V. Phone/Fax

Practice location:
  • Phone: 563-321-5706
  • Fax:
Mailing address:
  • Phone: 563-321-5706
  • 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: MR. SERGIO P CRUZ
Title or Position: CFO
Credential:
Phone: 781-708-9444