Healthcare Provider Details

I. General information

NPI: 1144544289
Provider Name (Legal Business Name): MENTOR ABI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 SUNBURY RD
WESTERVILLE OH
43082-8214
US

IV. Provider business mailing address

PO BOX 2825 306 W MILL ST
CARBONDALE IL
62902-2825
US

V. Phone/Fax

Practice location:
  • Phone: 614-000-0000
  • Fax: 614-000-0000
Mailing address:
  • Phone: 618-529-3060
  • Fax: 618-529-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER CUTLER
Title or Position: CFO
Credential:
Phone: 618-457-4729