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General NPI Number Information
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NPI Number | 1013093616
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Entity Type | Organization
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Legal Business Name | NATIONAL MENTOR HEALTHCARE NETWORK
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 03/04/2023
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Provider Practice Location Address
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Address Line | 4550 RICKER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32210-6308
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Country | US
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Telephone | 904-778-0935
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Fax | 904-778-8396
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Provider Business Mailing Address
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Address Line | 313 CONGRESS ST
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City | BOSTON
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State | MA
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Zip | 02210-1218
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Country | US
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Telephone | 800-388-5150
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Fax | 617-790-4271
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Authorized Official
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Title or Position | COO
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Name | BRETT IAN COHEN
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Credential |
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Telephone | 800-388-5150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 4060096
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License Number State | FL
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