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General NPI Number Information
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NPI Number | 1255281028
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Entity Type | Organization
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Legal Business Name | SHORE SIDE BEHAVIORAL HEALTH SERVICE, LLC
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 116 E 4TH AVE
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City | SOUTH SHORE
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State | KY
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Zip | 41175-8927
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Country | US
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Telephone | 606-498-4367
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Fax | 606-826-1780
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | SOUTH SHORE
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State | KY
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Zip | 41175-0204
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Country | US
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Telephone | 606-498-4367
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Fax | 606-826-1780
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Authorized Official
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Title or Position | OWNER, CHIEF CLINICIAN
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Name | DR. ROBERT BRYANT BENTLEY III
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Credential | DNP, PMHNP-BC
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Telephone | 606-498-4367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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