Provider Demographics
NPI:1093027179
Name:MENTOR HEALTHCARE LLC
Entity Type:Organization
Organization Name:MENTOR HEALTHCARE LLC
Other - Org Name:INDIANA MENTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC
Authorized Official - Phone:317-581-2380
Mailing Address - Street 1:8925 N MERIDIAN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2386
Mailing Address - Country:US
Mailing Address - Phone:317-581-2380
Mailing Address - Fax:317-581-2387
Practice Address - Street 1:8925 N MERIDIAN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2386
Practice Address - Country:US
Practice Address - Phone:317-581-2380
Practice Address - Fax:317-581-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health