MEDICARE: MENTOR ABI

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	320800000X	Mental Illness Community Based Residential Treatment Facility	0013091	WI

General Provider Information

NPI Number	:	1649574252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTOR ABI

Provider Business Mailing Address
First Line	:	10150 HIGHLAND MANOR DR STE 140
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-9712
Country	:	US
Telephone Number	:	813-626-1444
Fax Number	:	813-902-6719

Provider Business Practice Location Address
First Line	:	5310 BUENA PARK RD
Second Line	:
City	:	WATERFORD
State	:	WI
Zip	:	53185-2907
Country	:	US
Telephone Number	:	262-534-4864
Fax Number	:	262-546-0801

Authorized Official
Title or Position	:	CFO
Name	:	MR. CHRIS CUTLER
Credential	:
Telephone Number	:	618-457-4729

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	12/23/2010

Similar Medicare Providers

1508042961 — LAKEVIEW HEALTHCARE SYSTEMS WATERFORD
Practice Location Address:

5310 BUENA PARK RD
WATERFORD, WI
53185-2907

Practice Phone: 262-534-7297
Practice Fax:

1053243840 — RACHEL ANNE PANKONIN
Practice Location Address:

611 W MAIN ST
WATERFORD, WI
53185-4100

Practice Phone: 262-534-3189
Practice Fax: 262-534-4971

1225961816 — CHRISTA B KERNS
Practice Location Address:

819 W MAIN ST
WATERFORD, WI
53185-4025

Practice Phone: 262-514-8200
Practice Fax:

1578565388 — MRS. MELISSA DIANE MARTIN PT
Practice Location Address:

315 N MILWAUKEE ST
WATERFORD, WI
53185-4432

Practice Phone: 262-514-2700
Practice Fax: 262-514-3003

1396726873 — LAKEVIEW NEUROREHAB CENTER MIDWEST, INC
Practice Location Address:

1701 SHARP RD
WATERFORD, WI
53185-5214

Practice Phone: 262-534-7297
Practice Fax: 262-534-7257

1497731756 — DR. GEORGE E GILMORE IV M.D.
Practice Location Address:

818 FOREST LN
WATERFORD, WI
53185-4585

Practice Phone: 262-514-8199
Practice Fax:

Directions to “MENTOR ABI ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.