Provider Demographics
NPI:1669746038
Name:MENTOR ABI, LLC D/B/A NEURORESTORATIVE INDIANA
Entity type:Organization
Organization Name:MENTOR ABI, LLC D/B/A NEURORESTORATIVE INDIANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VP FOR THE CENTRAL DIV
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-529-3060
Mailing Address - Street 1:PO BOX 2825
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-2825
Mailing Address - Country:US
Mailing Address - Phone:618-529-3060
Mailing Address - Fax:618-529-8119
Practice Address - Street 1:2020 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-5005
Practice Address - Country:US
Practice Address - Phone:618-529-3060
Practice Address - Fax:618-529-8119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NMH HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital