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General NPI Number Information
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NPI Number | 1245342591
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Entity Type | Organization
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Legal Business Name | MENTOR ABI, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 15000 HIGHWAY 298
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City | BENTON
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State | AR
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Zip | 72019-9282
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Country | US
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Telephone | 501-758-8799
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Fax | 501-753-8204
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Provider Business Mailing Address
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Address Line | 280 MERRIMACK ST STE 600
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City | LAWRENCE
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State | MA
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Zip | 01843-1779
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Country | US
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Telephone | 501-758-8799
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Fax | 501-753-8204
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Authorized Official
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Title or Position | VP & SR ASST GENERAL COUNSEL
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Name | MARY PATRICIA RODENBERG-ROBERTS
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Credential |
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Telephone | 952-836-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283XC2000X
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Taxonomy Name | Children's Rehabilitation Hospital
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License Number | 10042
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 001
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License Number State | AR
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