MEDICARE: BENTLEY'S TRANSITION LIVING

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	323P00000X	Psychiatric Residential Treatment Facility		AZ

General Provider Information

NPI Number	:	1821365818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENTLEY'S TRANSITION LIVING

Provider Business Mailing Address
First Line	:	6432 S 23RD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-5357
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6432 SOUTH 23RD. AVENUE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-5357
Country	:	US
Telephone Number	:	602-539-2411
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MS. CARTLYNE ALEXIS
Credential	:	RN
Telephone Number	:	602-539-2411

Provider Enumeration Date	:	11/19/2011
Last Update Date	:	11/19/2011

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Directions to “BENTLEY'S TRANSITION LIVING ” Practice Location

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