MEDICARE: NATIONAL MENTOR HEALTHCARE, LLC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1619357886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL MENTOR HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	80 COTTONTAIL LN
Second Line	:	SUITE 330
City	:	SOMERSET
State	:	NJ
Zip	:	08873-1100
Country	:	US
Telephone Number	:	732-627-9890
Fax Number	:	732-563-6780

Provider Business Practice Location Address
First Line	:	180 ALYSSA DR
Second Line	:
City	:	MOUNT ROYAL
State	:	NJ
Zip	:	08061-1071
Country	:	US
Telephone Number	:	732-627-9890
Fax Number	:

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

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	03/12/2023

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