| Mentor Idaho, Llc | |
|
699 S Otter Ave Meridian ID 83642-6144 | |
| (951) 201-5914 | |
| Not Available |
| Full Name | Mentor Idaho, Llc |
|---|---|
| Speciality | Intermediate Care Facility, Intellectual Disabilities |
| Location | 699 S Otter Ave, Meridian, Idaho |
| Authorized Official Name and Position | Robin E Jacome (SR. BUSINESS DIRECTOR) |
| Authorized Official Contact | 9512015914 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mentor Idaho, Llc 9166 Anaheim Pl Ste 200 Rancho Cucamonga CA 91730-8547 Ph: (915) 201-5914 | Mentor Idaho, Llc 699 S Otter Ave Meridian ID 83642-6144 Ph: (951) 201-5914 |
| NPI Number | 1376129866 |
|---|---|
| Provider Enumeration Date | 03/23/2021 |
| Last Update Date | 05/26/2021 |
| Certification Date | 05/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376129866 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 315P00000X | Intermediate Care Facility, Intellectual Disabilities | (* (Not Available)) | Primary |
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