NPIMap

Organization Active NPI

National Mentor Healthcare Network

Doing business as Florida Mentor

  • Mental Illness Intermediate Care Facility
  • Jacksonville, FL
National Provider Identifier
1366598484
Registry record updated Mar 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
4037095 Issued in FL
Legal business name
NATIONAL MENTOR HEALTHCARE NETWORK
Doing business as
Florida Mentor
Practice address
5808 Kinkaid Rd
Jacksonville, FL 32244-1034
Phone
(904) 777-0460
Fax
(904) 778-9293
NPI assigned
Jan 25, 2007
Last updated
Mar 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 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
Mental Illness Intermediate Care Facility 310500000X 4037095 FL Primary

Addresses

Primary practice location

5808 Kinkaid Rd
Jacksonville, FL 32244-1034

Mailing address

5808 Kinkaid Rd
Jacksonville, FL 32244-1034
Phone (904) 777-0460

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 1366598484. Details of each certification follow.

  • CCN 10G064 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 10G064

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
Nov 30, 1983
Last certification
Oct 10, 2025
Beds
24
Ownership / control type
Private (proprietary)
Facility address
5808 Kinkaid Road
Jacksonville, FL 32244

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
10D0022925National Mentor Healthcare, Inc5808 Kinkaid Rd, Jacksonville, FL 32244Certificate of waiverDec 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
National Mentor Healthcare336 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678579200000",
    "number": "1366598484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5808 KINKAID RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322441034",
            "telephone_number": "904-777-0460",
            "fax_number": "904-778-9293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5808 KINKAID RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322441034",
            "telephone_number": "904-777-0460",
            "fax_number": "904-778-9293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL MENTOR HEALTHCARE NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2023-03-12",
        "certification_date": "2023-03-12",
        "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": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "FL",
            "license": "4037095",
            "primary": true
        }
    ],
    "identifiers": [],
    "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.