Provider Demographics
NPI:1245518539
Name:MENTIS OHIO, LLC
Entity type:Organization
Organization Name:MENTIS OHIO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-864-8996
Mailing Address - Street 1:6565 WEST LOOP SOUTH
Mailing Address - Street 2:STE. 410
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3519
Mailing Address - Country:US
Mailing Address - Phone:713-820-4200
Mailing Address - Fax:713-820-4220
Practice Address - Street 1:3625 MARSH RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-5823
Practice Address - Country:US
Practice Address - Phone:713-864-8996
Practice Address - Fax:713-820-4220
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTIS NEURO REHABILITATION, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-03
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities