| Florida Mentor | |
|
4550 Ricker Rd Jacksonville FL 32210-6308 | |
| (904) 778-0935 | |
| (904) 778-8396 |
| Full Name | Florida Mentor |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Intellectual And/or Developmental Disabilities |
| Location | 4550 Ricker Rd, Jacksonville, Florida |
| Authorized Official Name and Position | Brett Ian Cohen (COO) |
| Authorized Official Contact | 8003885150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Florida Mentor 313 Congress St Boston MA 02210-1218 Ph: (800) 388-5150 | Florida Mentor 4550 Ricker Rd Jacksonville FL 32210-6308 Ph: (904) 778-0935 |
| NPI Number | 1013093616 |
|---|---|
| Provider Enumeration Date | 10/27/2006 |
| Last Update Date | 03/04/2023 |
| Certification Date | 03/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013093616 | NPI | - | NPPES |
| 018500800 | Medicaid | FL | |
| 031258400 | Medicaid | FL |
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