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Mentor Idaho, LLC — NPI 1144896515, Boise, ID | NPI Central

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NPI 1144896515

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Mentor Idaho, LLC

NPI 1144896515 · Developmental Disabilities Clinic/Center · Boise, ID

Provider details

NPI number: 1144896515
Entity type: Organization
Primary specialty: Developmental Disabilities Clinic/CenterAmbulatory Health Care Facilities
Organization subpart: No
Authorized official: Robin Jacome, Sr. Business Director(951) 201-5914

Specialties & taxonomies

Developmental Disabilities Clinic/CenterPrimary261QD1600X
Ambulatory Health Care Facilities

Practice location

12553 W Explorer Dr Ste 190

Boise, ID 83713-1612

Phone: (951) 201-5914

Approximate (ZIP-level) locationGet directions

More ID providers

Mailing address

9166 Anaheim Place, Suie 200

Rancho Cucamonga, CA 91730

Other names (DBA / former)

Doing business as: Mentor Idaho, LLC

Registry dates

Enumerated: 2021-05-27
Last updated: 2021-05-27
Certified: 2021-05-17

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.