Healthcare Provider Details

I. General information

NPI: 1891012928
Provider Name (Legal Business Name): NATIONAL MENTOR HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 OAK BRANCH DR STE C
GREENSBORO NC
27407-2392
US

IV. Provider business mailing address

313 CONGRESS ST
BOSTON MA
02210-1218
US

V. Phone/Fax

Practice location:
  • Phone: 336-856-1140
  • Fax: 336-856-1128
Mailing address:
  • Phone: 800-388-5150
  • Fax: 617-790-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETT IAN COHEN
Title or Position: COO
Credential:
Phone: 800-388-5150