Mentor Idaho, LLC

NPI #1144896515 in Boise, Idaho

Provider Information

NPI Number: 1144896515
Entity Type: Organization
Organization Name: Mentor Idaho, LLC
Primary Specialty: Clinic/Center - Developmental Disabilities
Enumeration Date: May 27, 2021
Last Updated: May 27, 2021

Practice Location

Address: 12553 W EXPLORER DR STE 190
City: Boise
State: Idaho
ZIP Code: 83713-1612
Phone: (951) 201-5914

Authorized Official

Name: ROBIN E JACOME
Title: SR. BUSINESS DIRECTOR
Phone: (951) 201-5914

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Developmental Disabilities — Developmental Disabilities	261QD1600X	Primary

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