Provider Demographics
NPI:1891008991
Name:CAMP GRACE BENTLEY
Entity Type:Organization
Organization Name:CAMP GRACE BENTLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAMP DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PERRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-962-8242
Mailing Address - Street 1:8250 LAKESHORE RD
Mailing Address - Street 2:
Mailing Address - City:BURTCHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48059-1324
Mailing Address - Country:US
Mailing Address - Phone:313-962-8142
Mailing Address - Fax:
Practice Address - Street 1:1877 MARYLAND BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-4119
Practice Address - Country:US
Practice Address - Phone:313-962-8242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICR740200695385HR2050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp