NATIONAL MENTOR HEALTHCARE, LLC (NPI# 1184922882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184922882 |
| Entity Type | Organization |
| Organization Name | NATIONAL MENTOR HEALTHCARE, LLC |
| Other Organization Name | INDIANA MENTOR ADULT FOSTER CARE |
| Practice Address |
3324 Cherry Lake Rd Indianapolis IN 46235-8909 |
| Mailing Address |
8925 N Meridian St Suite 200 Indianapolis IN 46260-2386 |
| Practice Telephone | 3175812380 |
| Mailing Telephone | 3175812380 |
| Mailing Fax Number | 3175812378 |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2011-03-03 |
| Authorized Official Name | DAN MOHNKE (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3175812380 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | PROVIDER NUMBER | 2009433350Q | 01 |
| Other Name | Type Code |
|---|---|
| Indiana MENTOR Adult Foster Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730644725 | National Mentor Healthcare, LLC | Psychiatric Residential Treatment Facility | 4 Dogwood Ct, Hackettstown, NJ 07840-4800 | 2019-02-05 |
| 1568927556 | National Mentor Healthcare, LLC | Psychiatric Residential Treatment Facility | 143 Meadows Rd, Lafayette, NJ 07848-3120 | 2019-02-05 |
| 1548725534 | National Mentor Healthcare, LLC | Psychiatric Residential Treatment Facility | 23 Waterloo Rd, Stanhope, NJ 07874-3449 | 2019-02-05 |
| 1891250882 | National Mentor Healthcare, LLC | Psychiatric Residential Treatment Facility | 4 Tall Oaks Rd, Somerset, NJ 08873-3033 | 2019-02-05 |
| 1154886141 | National Mentor Healthcare, LLC | Psychiatric Residential Treatment Facility | 15 Rockleigh Dr, Ewing, NJ 08628-1516 | 2019-02-05 |
| 1366907354 | National Mentor Healthcare, LLC | Psychiatric Residential Treatment Facility | 23 Pritchard Ln, Sicklerville, NJ 08081-2013 | 2019-02-05 |
| 1114482007 | National Mentor Healthcare, LLC | Psychiatric Residential Treatment Facility | 270 Smithburg Rd, Manalapan, NJ 07726-8122 | 2019-02-05 |
| 1376008367 | National Mentor Healthcare, LLC | Psychiatric Residential Treatment Facility | 521 Townsbury Rd, Great Meadows, NJ 07838-2043 | 2019-02-05 |
| 1225593213 | National Mentor Healthcare, LLC | Psychiatric Residential Treatment Facility | 266 Jackson Mills Rd, Freehold, NJ 07728-8057 | 2019-02-05 |
| 1790235539 | National Mentor Healthcare, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 8 Dugans Grv, Millstone Twp, NJ 08535-8014 | 2016-10-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | NATIONAL MENTOR HEALTHCARE, LLC | 313 Congress St., Boston, MA 02210 |
| Indiana Business Entities | NATIONAL MENTOR HEALTHCARE, LLC | 313 Congress St, 5th Floor, Boston, MA 02210 |
| Street Address |
3324 CHERRY LAKE RD |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46235-8909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598313769 | Patricia Woodfaulk | Student in an Organized Health Care Education/Training Program | 4660 Birmingham Drive, Indianapolis, IN 46235 | 2019-08-30 |
| 1447743794 | Pamela Zirkle | Counselor | 4126 E. 10th St., Indianapolis, IN 46235 | 2018-06-12 |
| 1619467560 | Ronkisha L Russell | Behavior Technician | 9905 Fallcreek Rd, Indianapolis, IN 46235 | 2018-05-16 |
| 1386134690 | Kaitlin Abigail Waltz | Behavior Technician | 9905 Fall Creek Rd., Indianapolis, IN 46235 | 2018-05-11 |
| 1386132546 | Alexis Halpen | Behavior Technician | Damar Aba, 9905 Fall Creek Rd, Indianapolis, IN 46235 | 2018-04-24 |
| 1881712719 | Georgia Marie Brooks | Registered Nurse | 4065 Congaree Drive, Indianapolis, IN 46235 | 2007-03-27 |
| 1417042003 | The Health and Hospital Corporation of Marion County | Pharmacy | 9443 E 38th St, Indianapolis, IN 46235 | 2006-10-03 |
| 1366869828 | Mark M. Jamerson | Counselor | 9612 English Oak Dr, Indianapolis, IN 46235-1100 | 2014-03-23 |
| 1679981476 | Sylvester Carr Jr. | Counselor | 9443 Pepperidge Dr, Indianapolis, IN 46235-1162 | 2014-07-25 |
| 1366067159 | Amdaway Ibrahim | Counselor | 4013 Baker Dr, Indianapolis, IN 46235-1573 | 2020-06-08 |
| Find all providers in zip 46235 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093315095 | Shana P Graham | Custodial Care Facility | 8308 E 11th St, Indianapolis, IN 46219-4003 | 2020-10-28 |
| 1629513700 | Violet Johnson | Custodial Care Facility | 3213 N Riley Ave, Indianapolis, IN 46218-2350 | 2016-12-28 |
| 1477931764 | Grace Adult Family Care LLC | Custodial Care Facility | 2947 N Colorado Ave, Indianapolis, IN 46218-3116 | 2015-05-07 |
| 1730456575 | Amazing Grace Home Care LLC | Custodial Care Facility | 4825 W Beecher St, Indianapolis, IN 46241-4603 | 2011-11-22 |
| 1609162262 | National Mentor Healthcare, LLC | Custodial Care Facility | 8061 Folkstone Rd, Indianapolis, IN 46268-2029 | 2011-06-22 |
| 1255621561 | National Mentor Healthcare, LLC | Custodial Care Facility | 2815 Spring Meadow Ct, Indianapolis, IN 46268 | 2011-04-08 |
| 1124325790 | National Mentor Healthcare, LLC | Custodial Care Facility | 9901 Pendleton Pike, Lot 32, Indianapolis, IN 46236-2886 | 2011-02-17 |
| 1255635066 | Grimes Management Services, Inc. | Custodial Care Facility | 101 W Troy Ave, Indianapolis, IN 46225-2343 | 2011-01-07 |
| 1669781399 | National Mentor Healthcare, LLC | Custodial Care Facility | 602 Parkway Ave, Indianapolis, IN 46203-1840 | 2010-09-29 |
| 1023157559 | Eric Lamont Sanders | Custodial Care Facility | 4904 Hillside Ave, Indianapolis, IN 46205-1442 | 2007-02-05 |
| Find all providers in INDIANAPOLIS | ||||
| City | INDIANAPOLIS |
| Zip Code | 46235 |
Please comment or provide details below to improve the information on NATIONAL MENTOR HEALTHCARE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.