MEDICARE: VERONICA ELAINE BENTLEY

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	310400000X	Assisted Living Facility	AL12552	FL

General Provider Information

NPI Number	:	1295112811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA ELAINE BENTLEY

Provider Business Mailing Address
First Line	:	121 MARTIN CIR
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1708
Country	:	US
Telephone Number	:	914-349-1046
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 SEMINOLE LAKES DR
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-4207
Country	:	US
Telephone Number	:	914-349-1046
Fax Number	:	561-798-3394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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Directions to “ VERONICA ELAINE BENTLEY ” Practice Location

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