Provider Demographics
NPI:1801107941
Name:NATIONAL MENTOR HEALTHCARE LLC
Entity type:Organization
Organization Name:NATIONAL MENTOR HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEW SERVICES PROGRAM SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:HECKELSBERG
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:317-581-2380
Mailing Address - Street 1:8925 N MERIDIAN ST
Mailing Address - Street 2:STE. 250
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2386
Mailing Address - Country:US
Mailing Address - Phone:317-581-2380
Mailing Address - Fax:317-581-2387
Practice Address - Street 1:8925 N MERIDIAN ST
Practice Address - Street 2:STE. 250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2386
Practice Address - Country:US
Practice Address - Phone:317-581-2380
Practice Address - Fax:317-581-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency