Provider Demographics
NPI:1649409558
Name:BENTLEY SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:BENTLEY SENIOR LIVING, LLC
Other - Org Name:BENTLEY COMMONS AT BEDFORD
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOGUARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-644-2200
Mailing Address - Street 1:66 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6953
Mailing Address - Country:US
Mailing Address - Phone:603-644-2200
Mailing Address - Fax:603-644-2202
Practice Address - Street 1:66 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6953
Practice Address - Country:US
Practice Address - Phone:603-644-2200
Practice Address - Fax:603-644-2202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAPLAN DEVELOPMENT GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3348310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30597392Medicaid