Provider Demographics
NPI:1982029468
Name:REDINGTON-FAIRVIEW GENERAL HOSPITAL
Entity Type:Organization
Organization Name:REDINGTON-FAIRVIEW GENERAL HOSPITAL
Other - Org Name:SWING BED UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:H
Authorized Official - Last Name:DOUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-858-2176
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-474-5121
Mailing Address - Fax:207-474-9261
Practice Address - Street 1:46 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976
Practice Address - Country:US
Practice Address - Phone:207-474-5121
Practice Address - Fax:207-474-9261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDINGTON-FAIRVIEW GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME38550275N00000X
ME38968275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME38968OtherDHHS - STATE OF MAINE