Provider Demographics
NPI:1710099080
Name:MENTOR ABI, LLC
Entity Type:Organization
Organization Name:MENTOR ABI, LLC
Other - Org Name:NEURORESTORATIVE LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-708-9444
Mailing Address - Street 1:980 WASHINGTON ST STE 306
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6797
Mailing Address - Country:US
Mailing Address - Phone:781-708-9444
Mailing Address - Fax:501-753-8204
Practice Address - Street 1:46406 W LEE HUGHES RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-4757
Practice Address - Country:US
Practice Address - Phone:501-707-3262
Practice Address - Fax:501-753-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA004283X00000X, 311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility