NPIMap

Organization Active NPI

Massachusetts Mentor LLC

  • Foster Care Agency
  • Brockton, MA
National Provider Identifier
1811021090
Registry record updated Jun 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foster Care AgencyTaxonomy code 253J00000X
Legal business name
MASSACHUSETTS MENTOR LLC
Practice address
1115 W Chestnut St Ste 202
Brockton, MA 02301-7501
Phone
(781) 326-4207
Fax
(781) 326-4654
NPI assigned
Mar 16, 2007
Last updated
Jun 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1615 MA
Foster Care Agency 253J00000X Primary
In Home Supportive Care Agency 253Z00000X

Addresses

Primary practice location

1115 W Chestnut St Ste 202
Brockton, MA 02301-7501

Mailing address

6600 France Ave S Ste 350
Edina, MN 55435-1810
Phone (800) 388-5150

National Provider Directory

National Provider Directory
Tax ID family
Massachusetts Mentor 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.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781913600000",
    "number": "1811021090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S STE 350",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351810",
            "telephone_number": "800-388-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 W CHESTNUT ST STE 202",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017501",
            "telephone_number": "781-326-4207",
            "fax_number": "781-326-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSACHUSETTS MENTOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2026-06-20",
        "certification_date": "2026-06-20",
        "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": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MA",
            "license": "1615",
            "primary": false
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.