MEDICARE: NATIONAL MENTOR HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1366697948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL MENTOR HEALTH CARE

Provider Business Mailing Address
First Line	:	313 CONGRESS ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02210-1218
Country	:	US
Telephone Number	:	800-388-5150
Fax Number	:	617-790-4271

Provider Business Practice Location Address
First Line	:	8230 BAYCENTER RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7457
Country	:	US
Telephone Number	:	904-739-8015
Fax Number	:	904-448-6957

Authorized Official
Title or Position	:	COO
Name	:	BRETT IAN COHEN
Credential	:
Telephone Number	:	800-388-5150

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	03/12/2023

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