- Enrollment id
- O20040623000508
- Enrollment state
- MO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1720130701
- Multiple npi flag
- N
- Ccn
- 265732
- Associate id
- 4789669763
- Organization name
- ASHBY ROAD INC
- Doing business as name
- BENTLEYS EXTENDED CARE
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- BENTLEYS EXTENDED CARE
- Address line 1
- 3060 ASHBY RD
- City
- SAINT LOUIS
- State
- MO
- Zip code
- 631141342