Provider Demographics
NPI:1497160451
Name:MENTOR ABI, LLC
Entity Type:Organization
Organization Name:MENTOR ABI, LLC
Other - Org Name:NEURORESTORATIVE NORTH CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-626-1444
Mailing Address - Street 1:10150 HIGHLAND MANOR DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9713
Mailing Address - Country:US
Mailing Address - Phone:813-626-1444
Mailing Address - Fax:
Practice Address - Street 1:3601 WINDEMERE PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-5961
Practice Address - Country:US
Practice Address - Phone:202-425-6757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No251S00000XAgenciesCommunity/Behavioral Health