NPIMap

Organization Active NPI

Indiana Mentor

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Indianapolis, IN
National Provider Identifier
1407980170
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
200193830 Issued in IN
Legal business name
INDIANA MENTOR
Practice address
9000 Keystone Xing Ste 200
Indianapolis, IN 46240-2148
Phone
(317) 581-2380
NPI assigned
Mar 15, 2007
Last updated
Aug 25, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

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

Authorized official

Name
Mary Patricia Rodenberg-Roberts
Title
Chief Regulatory Officer Sr Asst GC
Phone
(952) 836-2234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 200193830 IN Primary

Addresses

Primary practice location

9000 Keystone Xing Ste 200
Indianapolis, IN 46240-2148

Mailing address

8777 Purdue Rd Ste 360
Indianapolis, IN 46268-3121
Phone (317) 208-7739

Other identifiers 2

IdentifierTypeStateIssuer
200193830OtherINPROVIDER NUMBER
300033125OtherINPROVIDER NUMBER

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 24

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

View all 24

Locations

8777 Purdue Rd
Ste 360
Indianapolis, IN 46268

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787616000000",
    "number": "1407980170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8777 PURDUE RD STE 360",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462683121",
            "telephone_number": "317-208-7739",
            "fax_number": "617-790-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 KEYSTONE XING STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462402148",
            "telephone_number": "317-581-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA MENTOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A",
        "authorized_official_last_name": "RODENBERG-ROBERTS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "CHIEF REGULATORY OFFICER SR ASST GC",
        "authorized_official_telephone_number": "952-836-2234"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IN",
            "license": "200193830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "200193830",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "300033125",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; 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.