Provider Demographics
NPI:1255583530
Name:BENTLEY MANOR, INC.
Entity type:Organization
Organization Name:BENTLEY MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:810-686-4858
Mailing Address - Street 1:2099 W WILSON RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1603
Mailing Address - Country:US
Mailing Address - Phone:810-686-4858
Mailing Address - Fax:810-686-4674
Practice Address - Street 1:2099 W WILSON RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1603
Practice Address - Country:US
Practice Address - Phone:810-686-4858
Practice Address - Fax:810-686-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS250010929320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities