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General NPI Number Information
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NPI Number | 1386879096
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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 | 05/26/2009
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 6 KING RD
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City | CHICHESTER
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State | NH
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Zip | 03258-6533
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Country | US
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Telephone | 603-798-3376
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Fax | 603-798-3748
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Provider Business Mailing Address
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Address Line | 639 GRANITE ST
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City | BRAINTREE
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State | MA
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Zip | 02184-5366
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Country | US
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Telephone | 781-356-6330
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Fax |
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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 | MBA
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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 | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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Taxonomy #4
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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 |
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License Number State |
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