Provider Demographics
NPI:1710383252
Name:NATIONAL MENTOR HEALTHCARE, LLC
Entity Type:Organization
Organization Name:NATIONAL MENTOR HEALTHCARE, LLC
Other - Org Name:ARIZONA MENTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-567-4919
Mailing Address - Street 1:2700 N 3RD ST
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1129
Mailing Address - Country:US
Mailing Address - Phone:602-200-9494
Mailing Address - Fax:602-567-2062
Practice Address - Street 1:9007 W DEANNA DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2418
Practice Address - Country:US
Practice Address - Phone:602-200-9494
Practice Address - Fax:602-567-2062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL MENTOR HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness