Healthcare Provider Details

I. General information

NPI: 1255281028
Provider Name (Legal Business Name): SHORE SIDE BEHAVIORAL HEALTH SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E 4TH AVE
SOUTH SHORE KY
41175-8927
US

IV. Provider business mailing address

PO BOX 204
SOUTH SHORE KY
41175-0204
US

V. Phone/Fax

Practice location:
  • Phone: 606-498-4367
  • Fax: 606-826-1780
Mailing address:
  • Phone: 606-498-4367
  • Fax: 606-826-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT BRYANT BENTLEY III
Title or Position: OWNER, CHIEF CLINICIAN
Credential: DNP, PMHNP-BC
Phone: 606-498-4367