NPIMap

Organization Active NPI

National Mentor Healthcare,LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Jacksonville, FL
National Provider Identifier
1720141542
Registry record updated Mar 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
4034096 Issued in FL
Legal business name
NATIONAL MENTOR HEALTHCARE,LLC
Practice address
3615 Hodges Blvd
Jacksonville, FL 32224-1288
Phone
(904) 223-4173
Fax
(904) 223-5611
NPI assigned
Dec 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 4034096 FL Primary

Addresses

Primary practice location

3615 Hodges Blvd
Jacksonville, FL 32224-1288

Mailing address

3615 Hodges Blvd
Jacksonville, FL 32224-1288
Phone (904) 223-4173

Other identifiers 1

IdentifierTypeStateIssuer
0312592 00MedicaidFL

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

3615 Hodges Blvd
Jacksonville, FL 32224
Phone (904) 223-4173

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679184000000",
    "number": "1720141542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 HODGES BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241288",
            "telephone_number": "904-223-4173",
            "fax_number": "904-223-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 HODGES BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241288",
            "telephone_number": "904-223-4173",
            "fax_number": "904-223-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL MENTOR HEALTHCARE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2023-03-19",
        "certification_date": "2023-03-19",
        "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": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "4034096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0312592 00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2023; 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.