MEDICARE: COVENTRY COUNTRY LIVING INC.

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	12552	FL

General Provider Information

NPI Number	:	1386003481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENTRY COUNTRY LIVING INC.

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

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. VERONICA ELAINE BENTLEY
Credential	:
Telephone Number	:	914-349-1046

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	02/17/2016

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