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National Mentor Healthcare, LLC

Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Bridgeton, NJ

NPI 1679953673 · NPPES record last updated Mar 12, 2023

Key facts

NPI
1679953673
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Legal business name
NATIONAL MENTOR HEALTHCARE, LLC
Practice address
493 Fairton Gouldtown Rd
Bridgeton, NJ 08302-7119
Phone
(732) 627-9890
NPI assigned
Jun 4, 2015
Organization subpart
No

Authorized official

Name
Brett Ian Cohen
Title
Coo
Phone
(800) 388-5150

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
California Mentor (336 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

493 Fairton Gouldtown Rd
Bridgeton, NJ 08302-7119

Mailing address

80 Cottontail LN
Suite 330
Somerset, NJ 08873-1100
Phone (732) 627-9890

Other names

  • New Jersey MENTOR Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 12, 2023.

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678579200000",
    "number": "1679953673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 COTTONTAIL LN",
            "address_2": "SUITE 330",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088731100",
            "telephone_number": "732-627-9890",
            "fax_number": "732-563-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 FAIRTON GOULDTOWN RD",
            "city": "BRIDGETON",
            "state": "NJ",
            "postal_code": "083027119",
            "telephone_number": "732-627-9890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL MENTOR HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "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": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Jersey MENTOR",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New Jersey MENTOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeton, NJ

All providers in Bridgeton, NJ · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Jersey

Sources for this page

Verify at the official NPI Registry.