Provider Demographics
NPI:1730365925
Name:NATIONAL MENTOR HEALTHCARE, LLC
Entity type:Organization
Organization Name:NATIONAL MENTOR HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-388-5150
Mailing Address - Street 1:280 BRIDGE ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1759
Mailing Address - Country:US
Mailing Address - Phone:781-326-4207
Mailing Address - Fax:781-326-4654
Practice Address - Street 1:350 HARVEY RD
Practice Address - Street 2:UNIT A-03-L
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3373
Practice Address - Country:US
Practice Address - Phone:603-622-3421
Practice Address - Fax:603-623-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH68561251B00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH820000748OtherTRADING PARTNERS ID
NH30855006Medicaid