| NPI | 1144896515 |
|---|---|
| Doing Business As | MENTOR IDAHO, LLC |
| Entity Type | Organization |
| Authorized Contact | ROBIN E JACOME Sr. Business Director 951-201-5914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2021-05-27 |