NATIONAL MENTOR HEALTHCARE, LLC (NPI# 1194034827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194034827 |
| Entity Type | Organization |
| Organization Name | NATIONAL MENTOR HEALTHCARE, LLC |
| Other Organization Name | INDIANA MENTOR ADULT FOSTER CARE |
| Practice Address |
719 Haney Ave South Bend IN 46613-2609 |
| Mailing Address |
8925 N Meridian St Suite 200 Indianapolis IN 46260-2386 |
| Practice Telephone | 3175812380 |
| Mailing Telephone | 3175812380 |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2010-09-29 |
| Authorized Official Name | DAN MOHNKE (STATE 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 | 200943350A | 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 |
719 HANEY AVE |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46613-2609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730330721 | Mindy Lynne Gradeless | Social Worker | 229 East Ewing Avenue, South Bend, IN 46613 | 2008-10-08 |
| 1689836405 | Staci-marie Balog Norman | Pharmacist | 760 West Cotter Street, South Bend, IN 46613 | 2008-07-02 |
| 1659386779 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1945 Lincolnway East, South Bend, IN 46613 | 2006-07-29 |
| 1003026642 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2105 Wabash St, South Bend, IN 46613-1138 | 2007-05-23 |
| 1366702060 | Clara M Davis | Private Vehicle | 1719 W Dubail St, South Bend, IN 46613-1216 | 2012-05-29 |
| 1215923313 | Gregory Matthew Ferro | Family Medicine | 1832 Prairie Ave, South Bend, IN 46613-1400 | 2005-09-23 |
| 1508330002 | Homeworks Construction Inc | Durable Medical Equipment & Medical Supplies | 1511 Pulaski St, South Bend, IN 46613-1404 | 2019-01-17 |
| 1477763415 | Logan Community Resources, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1917 S Walnut St, South Bend, IN 46613-1541 | 2007-05-22 |
| 1013117472 | Ronald E Grow Inc | Family Medicine | 810 W Indiana Ave, South Bend, IN 46613-1828 | 2007-07-23 |
| 1437444692 | Life Treatment Centers | Substance Abuse Rehabilitation Facility | 1402 S Michigan St, South Bend, IN 46613-2214 | 2011-06-16 |
| Find all providers in zip 46613 | ||||
| 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 |
|---|---|---|---|---|
| 1730650169 | Benson Ngarambe | Custodial Care Facility | 719 Roland Ct, South Bend, IN 46601-3461 | 2018-12-11 |
| 1497095327 | National Mentor Healthcare, LLC | Custodial Care Facility | 57155 White Pine Trl, South Bend, IN 46619-5584 | 2013-03-01 |
| 1154611861 | National Mentor Healthcare, LLC | Custodial Care Facility | 1434 Garland Cir, South Bend, IN 46614-2212 | 2011-04-14 |
| 1417267527 | National Mentor Healthcare, LLC | Custodial Care Facility | 1057 E Johnson Rd, South Bend, IN 46614-5493 | 2010-10-08 |
| 1285943993 | National Mentor Healthcare, LLC | Custodial Care Facility | 4203 Fellows St, South Bend, IN 46614-2644 | 2010-09-29 |
| 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 |
| 1164852505 | R&l Supportive Living Corp. | Custodial Care Facility | 3754 Jackson St, Gary, IN 46408-2226 | 2013-11-21 |
| 1932546959 | National Mentor Healtcare LLC | Custodial Care Facility | 6323 Tennessee Ave, Hammond, IN 46323-1934 | 2013-05-31 |
| 1598005423 | National Mentor Healthcare LLC | Custodial Care Facility | 6032 W 7th Ave, Gary, IN 46406-1314 | 2013-03-01 |
| 1821358342 | National Mentor Healthcare, LLC | Custodial Care Facility | 1726 N 100 W, Hartford City, IN 47348-9550 | 2012-05-17 |
| 1669732186 | National Mentor Healthcare, LLC | Custodial Care Facility | 2326 Flint Ct, Dyer, IN 46311-1913 | 2012-05-17 |
| 1720356082 | National Mentor Healthcare, LLC | Custodial Care Facility | 210 Fox Orchard Run, Fort Wayne, IN 46825-6579 | 2011-12-01 |
| 1730456575 | Amazing Grace Home Care LLC | Custodial Care Facility | 4825 W Beecher St, Indianapolis, IN 46241-4603 | 2011-11-22 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH BEND |
| Zip Code | 46613 |
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| 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.