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	251300000X	Local Education Agency (LEA)
2	251S00000X	Community/Behavioral Health Agency	201400	PA
3	251S00000X	Community/Behavioral Health Agency
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	251S00000X	Community/Behavioral Health Agency	200940	PA
6	251S00000X	Community/Behavioral Health Agency	465190	PA
7	251S00000X	Community/Behavioral Health Agency	354900	PA
8	251S00000X	Community/Behavioral Health Agency	0013499739-0010	PA
9	251S00000X	Community/Behavioral Health Agency	201020	PA
10	251S00000X	Community/Behavioral Health Agency	105910	PA

General Provider Information

NPI Number	:	1972667004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL MENTOR HEALTHCARE LLC

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	:	450 PARKWAY
Second Line	:	SUITE 204
City	:	BROOMALL
State	:	PA
Zip	:	19008-4202
Country	:	US
Telephone Number	:	610-353-5332
Fax Number	:	610-353-2814

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	03/19/2023

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