MEDICARE: BENTWOOD HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	040654	MO

General Provider Information

NPI Number	:	1265796387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENTWOOD HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1501 CHARBONIER RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5308
Country	:	US
Telephone Number	:	314-921-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 CHARBONIER RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5308
Country	:	US
Telephone Number	:	314-921-2700
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JUDAH BIENSTOCK
Credential	:
Telephone Number	:	314-812-2550

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	12/02/2015

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