Provider Demographics
NPI:1417043688
Name:LINCOLNHEALTH COVES EDGE
Entity Type:Organization
Organization Name:LINCOLNHEALTH COVES EDGE
Other - Org Name:RIVERSIDE ADULT DAY HABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRINTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-633-8413
Mailing Address - Street 1:26 SCHOONER ST
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4051
Mailing Address - Country:US
Mailing Address - Phone:207-563-4629
Mailing Address - Fax:207-563-4674
Practice Address - Street 1:51 SCHOONER ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4055
Practice Address - Country:US
Practice Address - Phone:207-563-4629
Practice Address - Fax:207-563-4674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLNHEALTH COVES EDGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS1131320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME112930200Medicaid