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General NPI Number Information
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NPI Number | 1144382136
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Entity Type | Organization
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Legal Business Name | NATIONAL MENTOR HEALTHCARE, LLC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 03/04/2023
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Provider Practice Location Address
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Address Line | 111 NE CAPRONA AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34983-8450
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Country | US
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Telephone | 772-879-1925
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Fax |
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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 | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 4017096
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License Number State | FL
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