Provider Demographics
NPI:1649662354
Name:MENTORS OF AMERICA, LLC
Entity type:Organization
Organization Name:MENTORS OF AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLIENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-819-4662
Mailing Address - Street 1:10475 CROSSPOINT BLVD
Mailing Address - Street 2:250
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3386
Mailing Address - Country:US
Mailing Address - Phone:866-819-4662
Mailing Address - Fax:866-819-4662
Practice Address - Street 1:10475 CROSSPOINT BLVD
Practice Address - Street 2:250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3386
Practice Address - Country:US
Practice Address - Phone:866-819-4662
Practice Address - Fax:866-819-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health