Provider Demographics
NPI:1396823340
Name:NATIONAL MENTOR HEALTHCARE, LLC
Entity Type:Organization
Organization Name:NATIONAL MENTOR HEALTHCARE, LLC
Other - Org Name:GEORGIA MENTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-388-5150
Mailing Address - Street 1:18 EXECUTIVE PARK DR NE
Mailing Address - Street 2:SUITE 1823
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2206
Mailing Address - Country:US
Mailing Address - Phone:404-728-1567
Mailing Address - Fax:404-982-9877
Practice Address - Street 1:18 EXECUTIVE PARK DR NE
Practice Address - Street 2:SUITE 1823
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2206
Practice Address - Country:US
Practice Address - Phone:404-728-1567
Practice Address - Fax:404-982-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000498847NMedicaid
GA000498847XMedicaid
GA000498847UMedicaid
GA000498847YMedicaid
GA000498847AMedicaid
GA000498847QMedicaid
GA000498847AAMedicaid
GA000498847KMedicaid
GA000498847ABMedicaid
GA000498847IMedicaid
GA000498847ZMedicaid