Mentor Abi
Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Waterford, WI
NPI 1649574252 · NPPES record last updated Dec 23, 2010
Key facts
- NPI
- 1649574252
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Illness Community Based Residential Treatment Facility 320800000X
- License
- 0013091 (WI)
- Legal business name
- MENTOR ABI
- Practice address
- 5310 Buena Park Rd
Waterford, WI 53185-2907 - Phone
- (262) 534-4864
- Fax
- (262) 546-0801
- NPI assigned
- Dec 23, 2010
- Organization subpart
- No
Authorized official
- Name
- Mr. Chris Cutler
- Title
- Cfo
- Phone
- (618) 457-4729
Corporate family (same tax ID) 36
National Provider Directory
- Tax ID family
- Mentor Abi
Locations
10150 Highland Manor Dr
Ste 140
Tampa, FL 33610
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 0013091 | WI | Yes |
Addresses
Primary practice location
5310 Buena Park Rd
Waterford, WI 53185-2907
Mailing address
10150 Highland Manor Dr Ste 140
Tampa, FL 33610-9712
Phone (813) 626-1444
Other names
- NeuroRestorative Wisconsin
Other providers in Waterford, WI
- Ursala B Marinan
- Andrew Paul Marlewski
- Melissa Diane Martin
- Rebekkah Denice McMillian
- Ryan James McNamara
- Maggie Elizabeth Meyer
- Julie Michals
- Julie Minikowski
- Dan Morrissey
- Teresa Anne Mrnik
All providers in Waterford, WI · Mental Illness Community Based Residential Treatment Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.