Mentor Idaho, LLC

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

MENTOR IDAHO, LLC

Practice address

699 S Otter Ave
Meridian, ID 83642-6144

Phone

(951) 201-5914

NPI assigned

Mar 23, 2021

Last updated

May 26, 2021By the provider in NPPES

Organization subpart

No

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 2

Addresses

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.

• Mentor Idaho, LLC

  • Developmental Disabilities Clinic/Center
  • Boise, ID
  • NPI 1144896515
  NPD tax ID
• Mentor Idaho, LLC

  • Developmental Disabilities Clinic/Center
  • Meridian, ID
  • NPI 1679148175
  NPD tax ID
• Rem Idaho, LLC

  • Developmental Disabilities Clinic/Center
  • Boise, ID
  • NPI 1689249369
  NPD tax ID

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1376129866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9166 ANAHEIM PL STE 200",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917308547",
            "telephone_number": "915-201-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "699 S OTTER AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426144",
            "telephone_number": "951-201-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTOR IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-23",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "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": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Kalani Mench, PA-C
• Chris Menchaca
• Adriane Joy Meng, LPC
• Jerry Meng, MD
• Natalie Meninga, RN
• Mentor Idaho, LLC
• Robert Menz, NP
• Mitchell Mercado
• William Chandler Merchant, DC
• Savannah Laurel Meredith

• Intellectual Disabilities Intermediate Care Facility in Meridian, ID
• Providers in Meridian, ID by specialty
• Intellectual Disabilities Intermediate Care Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.