Provider Demographics
NPI:1457319139
Name:HELEN B. BENTLEY FAMILY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:HELEN B. BENTLEY FAMILY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-447-4950
Mailing Address - Street 1:3090 SW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4311
Mailing Address - Country:US
Mailing Address - Phone:305-447-4950
Mailing Address - Fax:305-444-7866
Practice Address - Street 1:3090 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4311
Practice Address - Country:US
Practice Address - Phone:305-447-4950
Practice Address - Fax:305-444-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056077400Medicaid
FL029553100Medicaid
FL056077400Medicaid