OrganizationActive
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
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
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.