MENTOR ABI (NPI# 1649574252) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649574252 |
| Entity Type | Organization |
| Organization Name | MENTOR ABI |
| Other Organization Name | NEURORESTORATIVE WISCONSIN |
| Practice Address |
5310 Buena Park Rd Waterford WI 53185-2907 |
| Mailing Address |
10150 Highland Manor Dr Ste 140 Tampa FL 33610-9712 |
| Practice Telephone | 2625344864 |
| Practice Fax Number | 2625460801 |
| Mailing Telephone | 8136261444 |
| Mailing Fax Number | 8139026719 |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2010-12-23 |
| Authorized Official Name | MR. CHRIS CUTLER (CFO) |
| Authorized Official Telephone | 6184574729 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 0013091 | WI | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| NeuroRestorative Wisconsin | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265908388 | Mentor Abi | Rehabilitation Hospital | 115a Leeds Point Rd, Galloway, NJ 08205-4211 | 2018-10-16 |
| 1033426739 | Mentor Abi | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 986 Sebago Rd, Sebago, ME 04029-3814 | 2010-09-02 |
| 1740596568 | Mentor Abi | Community Based Residential Treatment Facility, Mental Illness | 2000 Crawford Pl Ste 700, Mount Laurel, NJ 08054-3950 | 2010-08-31 |
| 1023338639 | Mentor Abi | Rehabilitation Hospital | 446 Sycamore Road, Pleasanton, CA 94588 | 2010-06-04 |
| 1366762296 | Mentor Abi | Rehabilitation Hospital | 6512 E Ludlow Dr, Scottsdale, AZ 85254-3311 | 2010-06-02 |
| 1558686576 | Mentor Abi | Community Based Residential Treatment Facility, Mental Illness | 9125 Sw 55th Ave, Portland, OR 97219-5018 | 2010-04-01 |
| 1386879096 | Mentor Abi | Community Based Residential Treatment Facility, Mental Illness | 6 King Rd, Chichester, NH 03258-6533 | 2009-05-26 |
| 1669592234 | Mentor Abi | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1510 Seneca Dr, Blacksburg, VA 24060-2464 | 2007-03-29 |
| 1639476617 | Mentor Abi | Day Training, Developmentally Disabled Services | 4219 S County Trl, Charlestown, RI 02813-3628 | 2011-02-28 |
| 1013236124 | Mentor Abi | Rehabilitation Hospital | 639 Granite St, Suite 215, Braintree, MA 02184-5366 | 2010-05-28 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Mentor ABI LLC | 313 Congress St, Boston, Massachusetts 02210 |
| System for Award Management (SAM) Entities | MENTOR ABI, LLC | 313 Congress St, Boston, MA 02210-1218 |
| Iowa Business Entities | MENTOR ABI, LLC | 313 Congress Street 5th Floor, Boston, MA 02210 |
| Oklahoma Business Registrations | MENTOR ABI, LLC | 313 Congress St 5th Fl, C/o The Mentor Network, Boston, MA 02210 |
| Indiana Business Entities | MENTOR ABI, LLC | 313 Congress St, 5th Fl, Boston, MA 02210 |
| Street Address |
5310 BUENA PARK RD |
| City | WATERFORD |
| State | WI |
| Zip Code | 53185-2907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508042961 | Lakeview Healthcare Systems Waterford | Community Based Residential Treatment Facility, Mental Illness | 5310 Buena Park Rd, Waterford, WI 53185-2907 | 2008-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649755695 | Alyssa Jane Revolinski | Respite Care | 269435 S Elm Lane, Waterford, WI 53185 | 2018-09-26 |
| 1871973370 | Julie Minikowski | Community Health Worker | 207 Milwaukee Avenue, A, Waterford, WI 53185 | 2015-06-01 |
| 1629235031 | Fluegge Optical | Technician/Technologist | 920 E Main Street, Waterford, WI 53185 | 2008-05-22 |
| 1659598209 | Julie Michals | Occupational Therapist | 1701 Sharp Road, Waterford, WI 53185 | 2007-04-18 |
| 1518072768 | Jennifer Jayne Decker | Family Medicine | 818 Forrest Ln, Waterford, WI 53185 | 2006-08-20 |
| 1215966908 | Amy Beth Flock | Physical Therapy Assistant | 2319 Fox Knoll Dr, Waterford, WI 53185 | 2006-07-03 |
| 1750762472 | Tesalia R Renteria | Family Medicine | 818 Forest Ln, Waterford, WI 53185 | 2015-06-18 |
| 1649651092 | Kathryn C Halyko | Pediatrics | 818 Forest Ln, Waterford, WI 53185 | 2015-06-11 |
| 1518109735 | Daniel A Allison | Family Medicine | 818 Forest Ln, Waterford, WI 53185 | 2009-04-02 |
| 1811178478 | Daniel Mark Gifford | Speech-Language Pathologist | 1701 Sharp Rd, Lakeview Specialty Hospital, Waterford, WI 53185 | 2007-11-23 |
| Find all providers in zip 53185 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497282800 | Freedom Villa Inc | Community Based Residential Treatment Facility, Mental Illness | 3509 Elizabeth Lake Rd Ste 102, Waterford, MI 48328-3003 | 2017-05-16 |
| 1508042961 | Lakeview Healthcare Systems Waterford | Community Based Residential Treatment Facility, Mental Illness | 5310 Buena Park Rd, Waterford, WI 53185-2907 | 2008-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356953475 | County of Trempealeau | Community Based Residential Treatment Facility, Mental Illness | N36655 County Road Qqq, Whitehall, WI 54773-4401 | 2020-08-19 |
| 1932699873 | Dominique Lindsey | Community Based Residential Treatment Facility, Mental Illness | 4031 N 86th St, Milwaukee, WI 53222-1701 | 2018-05-16 |
| 1841706942 | Normic Enterprises Inc | Community Based Residential Treatment Facility, Mental Illness | N8761 Overland Dr, Watertown, WI 53094-9592 | 2017-12-27 |
| 1053858019 | Wise Management Inc. | Community Based Residential Treatment Facility, Mental Illness | 1538 W Liebau Rd, Mequon, WI 53092-2621 | 2017-01-27 |
| 1629513775 | Vessels of God | Community Based Residential Treatment Facility, Mental Illness | 2821 N 4th St # 304, Milwaukee, WI 53212-2362 | 2016-12-28 |
| 1871940213 | B.a.israel LLC | Community Based Residential Treatment Facility, Mental Illness | N9520 Silver Court, Appleton, WI 54915 | 2016-05-16 |
| 1104207497 | Platteville Family Resource Center | Community Based Residential Treatment Facility, Mental Illness | 155 W Lewis St, Platteville, WI 53818-2103 | 2015-06-12 |
| 1902214182 | Mental Health Services, Inc | Community Based Residential Treatment Facility, Mental Illness | 1117 Clara Ave, Sheboygan, WI 53081-5317 | 2014-07-31 |
| 1346658234 | Phoenix Recovery Services LLC | Community Based Residential Treatment Facility, Mental Illness | 600 W Hickory St, Gilman, WI 54433-0188 | 2014-07-24 |
| 1801214457 | Mikolaj Szypicyn | Community Based Residential Treatment Facility, Mental Illness | 261 3rd St, Reedsburg, WI 53959-1621 | 2014-04-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.