NPIMap

Organization Active NPI

Mentor Idaho, LLC

  • Developmental Disabilities Clinic/Center
  • Boise, ID
National Provider Identifier
1144896515
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
MENTOR IDAHO, LLC
Doing business as
Mentor Idaho, LLC
Practice address
12553 W Explorer Dr Ste 190
Boise, ID 83713-1612
Phone
(951) 201-5914
NPI assigned
May 27, 2021
Last updated
May 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Authorized official

Name
Robin E Jacome
Title
Sr. Business Director
Phone
(951) 201-5914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X NU Primary

Addresses

Primary practice location

12553 W Explorer Dr Ste 190
Boise, ID 83713-1612

Mailing address

9166 Anaheim Place, Suie 200
Rancho Cucamonga, CA 91730
Phone (951) 201-5914

Other names 1

  • Mentor Idaho, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mentor Idaho LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1622073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1144896515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9166 ANAHEIM PLACE, SUIE 200",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "91730",
            "telephone_number": "951-201-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12553 W EXPLORER DR STE 190",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131612",
            "telephone_number": "951-201-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTOR IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-27",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-17",
        "status": "A",
        "authorized_official_last_name": "JACOME",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "SR. BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "951-201-5914"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mentor Idaho, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.