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General NPI Number Information
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NPI Number | 1093027179
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Entity Type | Organization
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Legal Business Name | MENTOR HEALTHCARE LLC
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 8925 N MERIDIAN ST SUITE 250
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2386
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Country | US
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Telephone | 317-581-2380
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Fax | 317-581-2387
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Provider Business Mailing Address
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Address Line | 8925 N MERIDIAN ST SUITE 250
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2386
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Country | US
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Telephone | 317-581-2380
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Fax | 317-581-2387
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Authorized Official
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Title or Position | PROGRAM SUPERVISOR
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Name | MRS. JEANNA R KNIGHT
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Credential | MA, NCC
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Telephone | 317-581-2380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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