Provider Demographics
NPI:1861568990
Name:OHIO MENTOR, INC.
Entity type:Organization
Organization Name:OHIO MENTOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:STONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-785-2458
Mailing Address - Street 1:6200 ROCKSIDE WOODS BLVD N STE 305
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2343
Mailing Address - Country:US
Mailing Address - Phone:216-525-1885
Mailing Address - Fax:216-525-1894
Practice Address - Street 1:6200 ROCKSIDE WOODS BLVD N STE 305
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2343
Practice Address - Country:US
Practice Address - Phone:216-525-1885
Practice Address - Fax:216-525-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0528251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
12176Medicare UPIN