Provider Demographics
NPI:1427193358
Name:NATIONAL MENTOR HEALTHCARE, LLC
Entity Type:Organization
Organization Name:NATIONAL MENTOR HEALTHCARE, LLC
Other - Org Name:DBA NC 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 1:313 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-1218
Mailing Address - Country:US
Mailing Address - Phone:800-388-5150
Mailing Address - Fax:617-790-4271
Practice Address - Street 1:8604 CLIFF CAMERON DRIVE
Practice Address - Street 2:SUITE 170
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8508
Practice Address - Country:US
Practice Address - Phone:704-594-9837
Practice Address - Fax:704-594-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251S00000X
NC251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301529Medicaid
=========OtherFEDERAL TAX ID NUMBER