MEDICARE: INDIANA MENTOR

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	251B00000X	Case Management Agency		IN

General Provider Information

NPI Number	:	1588786107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA MENTOR

Provider Business Mailing Address
First Line	:	8925 N MERIDIAN ST
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2386
Country	:	US
Telephone Number	:	317-581-2380
Fax Number	:	317-581-2378

Provider Business Practice Location Address
First Line	:	8925 N MERIDIAN ST
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2386
Country	:	US
Telephone Number	:	317-581-2380
Fax Number	:	317-581-2378

Authorized Official
Title or Position	:	STATE DIRECTOR
Name	:	DAN MOHNKE
Credential	:
Telephone Number	:	317-581-2380

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/22/2020

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1700892809 — BETH L BROGAN MD
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Practice Location Address:

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Directions to “INDIANA MENTOR ” Practice Location

Language	Start Address	Practice Location

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