Provider Demographics
NPI:1790453751
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:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RACINE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:207-290-1450
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04487-0027
Mailing Address - Country:US
Mailing Address - Phone:207-290-1450
Mailing Address - Fax:
Practice Address - Street 1:213 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4001
Practice Address - Country:US
Practice Address - Phone:207-403-9215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERS EDGE BEHAVIORAL HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty