NPI age
4 years
Enumerated 2021-05-26
● Active Type 2 · Organization
Mentor Idaho, Llc
Mentor Idaho, Llc is 1 of 40 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Jacome
SR. Business Director
Last NPPES update
2021-05-26
Source: monthly bulk 2026-05
How this organization compares
Across 40 active clinic/center providers in Idaho.
NPI age
4 years
≈ at median (4 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2021 → 2026
2021-05Enumerated in NPPES
2021
2026
Where they practice
Primary practice location
1001 W Broadway Ave Apt A104
Meridian, ID 836423730
Mailing address
9166 Anaheim Pl Ste 200
Rancho Cucamonga, CA 917308547
Authorized official
Robin Jacome
SR. Business Director
📞 9512015914
Specialties
-
Clinic/Center PrimaryAn 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...
Practice context
Single-site organization. Only one practice location on file.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.