OrganizationActive
Mentor Idaho, LLC
NPI 1679148175 · Developmental Disabilities Clinic/Center · Meridian, ID
Provider details
- NPI number
- 1679148175
- Entity type
- Organization
- Primary specialty
- Developmental Disabilities Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Robin Jacome, Sr. Business Director
Practice location
1001 W Broadway Ave Apt A104
Meridian, ID 83642-3730
Phone: (951) 201-5914
Mailing address
9166 Anaheim Pl Ste 200
Rancho Cucamonga, CA 91730-8547
Registry dates
- Enumerated
- 2021-05-26
- Last updated
- 2021-05-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.