Provider Demographics
NPI:1124271531
Name:BENTLEY SAINT FRANCIS, LLC
Entity type:Organization
Organization Name:BENTLEY SAINT FRANCIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-372-4004
Mailing Address - Street 1:57 WINGATE ST
Mailing Address - Street 2:C/O LANDMARK HEALTH SOLUTIONS, LLC
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5722
Mailing Address - Country:US
Mailing Address - Phone:978-372-4004
Mailing Address - Fax:978-372-3239
Practice Address - Street 1:101 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-3025
Practice Address - Country:US
Practice Address - Phone:508-755-8605
Practice Address - Fax:508-791-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA085314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0941123Medicaid
MA0941123Medicaid