Healthcare Provider Details

I. General information

NPI: 1841496593
Provider Name (Legal Business Name): NATIONAL MENTOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 E FULTON TER
GARDEN CITY KS
67846-6165
US

IV. Provider business mailing address

1110 W WILLIAM CANNON DR #500
AUSTIN TX
78745-5468
US

V. Phone/Fax

Practice location:
  • Phone: 620-272-0499
  • Fax: 620-272-0599
Mailing address:
  • Phone: 512-326-8866
  • Fax: 512-326-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0056897-003
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0056897-003
License Number StateKS

VIII. Authorized Official

Name: DORIS DAVILA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 512-326-8866