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General NPI Number Information
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NPI Number | 1245518539
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Entity Type | Organization
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Legal Business Name | MENTIS OHIO, LLC
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 3625 MARSH RD
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City | STOW
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State | OH
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Zip | 44224-5823
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Country | US
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Telephone | 713-864-8996
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Fax | 713-820-4220
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Provider Business Mailing Address
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Address Line | 6565 WEST LOOP SOUTH STE. 410
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City | BELLAIRE
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State | TX
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Zip | 77401-3519
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Country | US
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Telephone | 713-820-4200
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Fax | 713-820-4220
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MARK L. QUIGLEY
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Credential |
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Telephone | 713-864-8996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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