NPIMap

Organization Active NPI

Mentor Idaho, LLC

  • Developmental Disabilities Clinic/Center
  • Meridian, ID
National Provider Identifier
1679148175
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
MENTOR IDAHO, LLC
Practice address
1001 W Broadway Ave Apt A104
Meridian, ID 83642-3730
Phone
(951) 201-5914
NPI assigned
May 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

1001 W Broadway Ave Apt A104
Meridian, ID 83642-3730

Mailing address

9166 Anaheim PL Ste 200
Rancho Cucamonga, CA 91730-8547
Phone (951) 201-5914

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": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621987200000",
    "number": "1679148175",
    "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": "951-201-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W BROADWAY AVE APT A104",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423730",
            "telephone_number": "951-201-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTOR IDAHO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-26",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A",
        "authorized_official_last_name": "JACOME",
        "authorized_official_first_name": "ROBIN",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • 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.