NPIMap

Organization Active NPI

National Mentor Healthcare LLC

Doing business as Indiana MENTOR Adult Foster Care

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Michigan City, IN
National Provider Identifier
1902115645
Registry record updated Mar 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
NATIONAL MENTOR HEALTHCARE LLC
Doing business as
Indiana MENTOR Adult Foster Care
Practice address
214 Broadway St
Michigan City, IN 46360-5009
Phone
(317) 581-2380
NPI assigned
Sep 29, 2010
Last updated
Mar 19, 2023By the provider in NPPES
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 Community Based Residential Treatment Facility 320900000X NU Primary

Addresses

Primary practice location

214 Broadway St
Michigan City, IN 46360-5009

Mailing address

313 Congress St
Boston, MA 02210-1218
Phone (800) 388-5150

Other identifiers 1

IdentifierTypeStateIssuer
200193830UOtherINPROVIDER NUMBER

Other names 1

  • Indiana MENTOR Adult Foster Care Doing business as

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 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1285718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679184000000",
    "number": "1902115645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 CONGRESS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022101218",
            "telephone_number": "800-388-5150",
            "fax_number": "617-790-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 BROADWAY ST",
            "city": "MICHIGAN CITY",
            "state": "IN",
            "postal_code": "463605009",
            "telephone_number": "317-581-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIONAL MENTOR HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-29",
        "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": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "200193830U",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana MENTOR Adult Foster Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Indiana MENTOR Adult Foster Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Michigan City, IN

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.