NPIMap

Organization Active NPI

National Mentor Healthcare, LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Port St Lucie, FL
National Provider Identifier
1144382136
Registry record updated Mar 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
4017096 Issued in FL
Legal business name
NATIONAL MENTOR HEALTHCARE, LLC
Practice address
111 NE Caprona Ave
Port St Lucie, FL 34983-8450
Phone
(772) 879-1925
NPI assigned
Dec 15, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 4017096 FL Primary

Addresses

Primary practice location

111 NE Caprona Ave
Port St Lucie, FL 34983-8450

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0312657MedicaidFL

Other names 1

  • Florida Mentor Other name

Medicare participation

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

Intermediate care facility for individuals with intellectual disabilities certification: CCN 10G085

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
Apr 22, 1993
Last certification
Apr 29, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
111 NE Caprona Avenue
Port Saint Lucie, FL 34983

National Provider Directory

National Provider Directory
Tax ID family
California Mentor336 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677888000000",
    "number": "1144382136",
    "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": "111 NE CAPRONA AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349838450",
            "telephone_number": "772-879-1925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL MENTOR HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "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": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "4017096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0312657",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Mentor",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Florida Mentor",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.