Provider Demographics
NPI:1699040584
Name:MENTOR PLUS INC.
Entity Type:Organization
Organization Name:MENTOR PLUS INC.
Other - Org Name:MENTOR PLUS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/ DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GOODWIN
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:888-986-5646
Mailing Address - Street 1:114-A SOUTH COMMERCIAL CIR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:188-986-5646
Mailing Address - Fax:
Practice Address - Street 1:114-A SOUTH COMMERCIAL CIR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:188-986-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health