Healthcare Provider Details

I. General information

NPI: 1619886751
Provider Name (Legal Business Name): CASSEY BENTLEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 DAVIS AVE
MORGANTOWN WV
26501-3811
US

IV. Provider business mailing address

511 DAVIS AVE
MORGANTOWN WV
26501-3811
US

V. Phone/Fax

Practice location:
  • Phone: 304-382-4116
  • Fax:
Mailing address:
  • Phone: 304-382-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: