NPIMap

Organization Active NPI

National Mentor Healthcare Network

Doing business as Florida Mentor

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Jacksonville, FL
National Provider Identifier
1013093616
Registry record updated Mar 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
4060096 Issued in FL
Legal business name
NATIONAL MENTOR HEALTHCARE NETWORK
Doing business as
Florida Mentor
Practice address
4550 Ricker Rd
Jacksonville, FL 32210-6308
Phone
(904) 778-0935
Fax
(904) 778-8396
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brett Ian Cohen
Title
Coo
Phone
(800) 388-5150

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103K00000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 4060096 FL Primary

Addresses

Primary practice location

4550 Ricker Rd
Jacksonville, FL 32210-6308

Mailing address

313 Congress St
Boston, MA 02210-1218
Phone (800) 388-5150

Other identifiers 2

IdentifierTypeStateIssuer
018500800MedicaidFL
031258400MedicaidFL

Other names 1

  • Florida Mentor Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013093616. Details of each certification follow.

  • CCN 10G070 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 10G070

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FLORIDA MENTOR
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 16, 1984
Last certification
Mar 12, 2025
Beds
24
Ownership / control type
Private (proprietary)
Facility address
4550 Ricker Road
Jacksonville, FL 32210

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1031830Florida Mentor-Point West Cluster4550 Ricker Rd, Jacksonville, FL 32210Certificate of waiverOct 11, 2026

National Provider Directory

National Provider Directory
Tax ID family
National Mentor Healthcare LLC336 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

3258 Parkside Center Cir
Tampa, FL 33619
Phone (813) 630-1746

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677888000000",
    "number": "1013093616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 CONGRESS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022101218",
            "telephone_number": "800-388-5150",
            "fax_number": "617-790-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 RICKER RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322106308",
            "telephone_number": "904-778-0935",
            "fax_number": "904-778-8396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL MENTOR HEALTHCARE NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2023-03-04",
        "certification_date": "2023-03-04",
        "status": "A",
        "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"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "4060096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018500800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031258400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Mentor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Florida Mentor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.