Provider Demographics
NPI:1659985125
Name:RIVERS EDGE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:RIVERS EDGE BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-738-2488
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04487
Mailing Address - Country:US
Mailing Address - Phone:207-738-2488
Mailing Address - Fax:207-738-3815
Practice Address - Street 1:883 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:ME
Practice Address - Zip Code:04487
Practice Address - Country:US
Practice Address - Phone:207-738-2488
Practice Address - Fax:207-738-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility