MEDICARE: NATIONAL MENTOR HEALTH CARE 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1750405593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL MENTOR HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	701 NORTHPOINT PKWY
Second Line	:	SUITE 315
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1950
Country	:	US
Telephone Number	:	561-656-4106
Fax Number	:	561-656-4163

Provider Business Practice Location Address
First Line	:	701 NORTHPOINT PKWY
Second Line	:	SUITE 315
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1950
Country	:	US
Telephone Number	:	561-656-4106
Fax Number	:	561-656-4163

Authorized Official
Title or Position	:	STATE DIRECTOR
Name	:	WILLIAM ALLEN
Credential	:
Telephone Number	:	305-598-0242

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/22/2020

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