20D2238534 CLIA NUMBER - MENTOR ABI LLC NEURORESTORATIVE-MAINE (LODGE)

Laboratory Demographics

CLIA Code: 20D2238534
Facility Name: MENTOR ABI LLC NEURORESTORATIVE-MAINE (LODGE)
Facility Address: 1014 SEBAGO RD
SEBAGO, ME
ZIP 04029
Facility Phone: 207 239-0124
Facility Type: Other - RES. CARE GROUPE HM.
Facility Type: Waiver
Lab Director: JENNIFER L. JELLO
NPI Number: 1033426739
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	20D2238534
LAB Type	Other - RES. CARE GROUPE HM.
Facility Name	MENTOR ABI LLC NEURORESTORATIVE-MAINE (LODGE)
Street	1014 SEBAGO RD
City	SEBAGO
State	ME
ZIP	04029
Phone	207 239-0124
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	10/5/2025
Certificate Expiration Date	10/4/2027
Facility Type	Other - RES. CARE GROUPE HM.
Lab Director	JENNIFER L. JELLO

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This page was last updated on: 9/29/2025