1. Home
  2. Directory
  3. Idaho
  4. Boise
  5. Clinic Center
  6. NPI Profile

MENTOR IDAHO, LLC
NPI 1144896515
Clinic/Center - Developmental Disabilities in Boise, ID

Active since May 27, 2021
12553 W EXPLORER DR STE 190, BOISE, ID 83713(951) 201-5914 Get Directions Write a Review

NPPES record last updated: May 27, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mentor Idaho, Llc NPPES

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

MENTOR IDAHO, LLC (NPI 1144896515) is a healthcare organization registered as a developmental disabilities in Boise, Idaho and active in the NPI registry since May 2021. The organization lists Robin E Jacome, Sr. Business Director, as its authorized official.

NPPES Registry Identity

NPI1144896515
Entity TypeOrganization
Primary Taxonomy261QD1600X
Legal Business NameMENTOR IDAHO, LLC
Location Address12553 W EXPLORER DR STE 190Boise, ID 83713-1612
Mailing Address9166 Anaheim Place, Suie 200Rancho Cucamonga, CA 91730 · (951) 201-5914
Phone(951) 201-5914
Organization SubpartNo
Authorized OfficialRobin E JacomeSr. Business Director · (951) 201-5914
Enumeration DateMay 27, 2021
NPPES CertifiedMay 17, 2021
✔ NPI 1144896515 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Developmental DisabilitiesAmbulatory Health Care Facilities
Taxonomy Code261QD1600X
Definition

An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).

12553 W EXPLORER DR STE 190, Boise, ID 83713
Open in Google Maps ↗

Other Names 1

Doing Business AsMentor Idaho, Llc

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMBER LAROCCO CADC
Peer Specialist
12553 W EXPLORER DR STE 190
BOISE, ID 83713
Ada County (208) 376-7083
CADEN SEAN BENZINGER LPC
Counselor
12553 W EXPLORER DR STE 190
BOISE, ID 83713
Ada County (208) 376-7083
SARAH E SAMSON LCSW
Counselor (Addiction (Substance Use Disorder))
12553 W EXPLORER DR STE 190
BOISE, ID 83713
Ada County (208) 376-7083
MONICA VIRGEN
Behavior Technician
12553 W EXPLORER DR STE 190
BOISE, ID 83713
Ada County (208) 972-5254
TRIVIUM LIFE SERVICES MOUNTAIN WEST, LLC
Clinic/Center (Mental Health (Including Community Mental Health Center))
12553 W EXPLORER DR STE 190
BOISE, ID 83713
Ada County (208) 376-7083
DARBY ALISON OTTINGER
Behavior Technician
12553 W EXPLORER DR STE 190
BOISE, ID 83713
Ada County (208) 972-5254
NICOLE LAINE MARTINEZ
Behavior Technician
12553 W EXPLORER DR STE 190
BOISE, ID 83713
Ada County (208) 972-5254
CARRIE MCNEIL
Case Manager/Care Coordinator
12553 W EXPLORER DR STE 190
BOISE, ID 83713
Ada County (208) 488-1531

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 Mentor Idaho, LLC's NPI number?

The NPI number for Mentor Idaho, LLC is 1144896515. It was assigned to this organization in the NPPES registry on May 27, 2021.

Where is Mentor Idaho, LLC located?

Mentor Idaho, LLC is located at 12553 W Explorer Dr Ste 190, Boise, ID 83713. The listed phone number is (951) 201-5914.

What is Mentor Idaho, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Developmental Disabilities, with taxonomy code 261QD1600X.

When was this NPI record last updated?

The NPPES record for Mentor Idaho, LLC was last updated on May 27, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.