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FLORIDA MENTOR
NPI 1013093616
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Jacksonville, FL

Active since October 27, 2006CLIA 10D1031830 · Waiver
4550 RICKER RD, JACKSONVILLE, FL 32210(904) 778-0935(904) 778-8396 Get Directions Write a Review

NPPES record last updated: March 4, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 4, 2023, Dec 19, 2016, Oct 27, 2016 (3 updates tracked since 2016).

About Florida Mentor NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FLORIDA MENTOR (NPI 1013093616) is a healthcare organization registered as a community based residential treatment facility, intellectual and/or developmental disabilities in Jacksonville, Florida and active in the NPI registry since October 2006. The organization holds a CLIA Waiver certificate valid through October 11, 2026 and lists Brett Ian Cohen, Coo, as its authorized official.

NPPES Registry Identity

NPI1013093616
Entity TypeOrganization
Primary Taxonomy320900000X
Legal Business NameNATIONAL MENTOR HEALTHCARE NETWORK
Location Address4550 RICKER RDJacksonville, FL 32210-6308
Mailing Address313 Congress StBoston, MA 02210-1218 · (800) 388-5150 · Fax (617) 790-4271
Phone(904) 778-0935
Fax(904) 778-8396
Organization SubpartNo
Authorized OfficialBrett Ian CohenCoo · (800) 388-5150
Enumeration DateOctober 27, 2006
Last NPPES UpdateMarch 4, 20233 updates tracked since enumeration
NPPES CertifiedMarch 4, 2023
✔ NPI 1013093616 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320900000X
License✔ Licensed in FL · 4060096
Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

Also ListedBehavior AnalystTaxonomy 103K00000X
4550 RICKER RD, Jacksonville, FL 32210
Open in Google Maps ↗

Other Names 1

Doing Business AsFlorida Mentor

Other Identifiers 2

Medicaid018500800FL
Medicaid031258400FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D1031830

Florida Mentor-Point West Cluster · Jacksonville, FL
Active · expires Oct 11, 2026
CLIA Number10D1031830
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateOctober 12, 2024
Certificate Expiration DateOctober 11, 2026
Laboratory DirectorTonya Ferrell
Laboratory Phone(904) 778-0935
Laboratory LocationFlorida Mentor-Point West Cluster4550 Ricker Rd, Jacksonville, FL 32210
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is National Mentor Healthcare Network's NPI number?

The NPI number for National Mentor Healthcare Network is 1013093616. It was assigned to this organization in the NPPES registry on October 27, 2006. The provider is doing business as Florida Mentor.

Where is National Mentor Healthcare Network located?

National Mentor Healthcare Network is located at 4550 Ricker Rd, Jacksonville, FL 32210. The listed phone number is (904) 778-0935.

What is National Mentor Healthcare Network's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

Does National Mentor Healthcare Network hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1031830) is associated with this NPI, valid through October 11, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for National Mentor Healthcare Network was last updated on March 4, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.