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General NPI Number Information
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NPI Number | 1831422500
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Entity Type | Organization
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Legal Business Name | CLASSIC BENTLEY VILLAGE, INC
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 875 RETREAT DR
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City | NAPLES
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State | FL
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Zip | 34110-7927
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Country | US
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Telephone | 239-738-4199
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Fax | 239-513-9032
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Provider Business Mailing Address
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Address Line | 875 RETREAT DR
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City | NAPLES
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State | FL
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Zip | 34110-7927
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Country | US
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Telephone | 239-738-4199
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Fax | 239-513-9032
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BETTY LAUFFER
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Credential |
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Telephone | 239-738-4199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299991165
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License Number State | FL
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