Provider Demographics
NPI:1568522050
Name:LEDGEWOOD MANOR, INC
Entity Type:Organization
Organization Name:LEDGEWOOD MANOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-892-2261
Mailing Address - Street 1:200 TANDBERG TRL
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5103
Mailing Address - Country:US
Mailing Address - Phone:207-892-2261
Mailing Address - Fax:207-892-7574
Practice Address - Street 1:200 TANDBERG TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5103
Practice Address - Country:US
Practice Address - Phone:207-892-2261
Practice Address - Fax:207-892-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME205137Medicare ID - Type UnspecifiedPROVIDER NUMBER