Healthcare Provider Details

I. General information

NPI: 1194146340
Provider Name (Legal Business Name): NATIONAL MENTOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 DIELMAN INDUSTRIAL DR
OLIVETTE MO
63132-2212
US

IV. Provider business mailing address

9375 DIELMAN INDUSTRIAL DR
OLIVETTE MO
63132-2212
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-7944
  • Fax: 314-991-6642
Mailing address:
  • Phone: 314-991-7944
  • Fax: 314-991-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RACHEL KRAMER
Title or Position: SR DIRECTOR OF OPERATIONS
Credential:
Phone: 314-991-7944