Provider Demographics
NPI:1982706347
Name:HELEN B. BENTLEY FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:HELEN B. BENTLEY FAMILY HEALTH CENTER
Other - Org Name:HELEN B. BENTLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:305-351-1362
Mailing Address - Street 1:3090 S DOUGLAS RD
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:305-351-1362
Mailing Address - Fax:305-351-1297
Practice Address - Street 1:3090 S DOUGLAS RD
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:305-351-1362
Practice Address - Fax:305-351-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH18014261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)