Healthcare Provider Details

I. General information

NPI: 1861607186
Provider Name (Legal Business Name): NATIONAL MENTOR HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 FREIDRICH LN BLDG N SUITE G
AUSTIN TX
78744-1800
US

IV. Provider business mailing address

313 CONGRESS ST
BOSTON MA
02210-1218
US

V. Phone/Fax

Practice location:
  • Phone: 512-326-8866
  • Fax: 512-326-4102
Mailing address:
  • Phone: 800-388-5150
  • Fax: 617-790-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30997
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0000H08EW
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number0000H08EW
License Number StateTX

VIII. Authorized Official

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