1790235539 NPI number — NATIONAL MENTOR HEALTHCARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790235539 NPI number — NATIONAL MENTOR HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL MENTOR HEALTHCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790235539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 COTTONTAIL LN
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08873-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-627-9890
Provider Business Mailing Address Fax Number:
732-563-6780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 DUGANS GRV
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLSTONE TWP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08535-8014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-627-9890
Provider Business Practice Location Address Fax Number:
732-563-6780
Provider Enumeration Date:
10/05/2016

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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