Provider Demographics
NPI:1336373588
Name:COASTAL KIDS PRESCHOOL
Entity Type:Organization
Organization Name:COASTAL KIDS PRESCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:CONGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-563-5335
Mailing Address - Street 1:12 JACKIES TRL
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4253
Mailing Address - Country:US
Mailing Address - Phone:207-563-5335
Mailing Address - Fax:
Practice Address - Street 1:12 JACKIES TRL
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4253
Practice Address - Country:US
Practice Address - Phone:207-563-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-03
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME388420252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME165630200Medicare PIN