Healthcare Provider Details

I. General information

NPI: 1790453751
Provider Name (Legal Business Name): RIVERS EDGE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W BROADWAY
LINCOLN ME
04457-4001
US

IV. Provider business mailing address

PO BOX 27
SPRINGFIELD ME
04487-0027
US

V. Phone/Fax

Practice location:
  • Phone: 207-403-9215
  • Fax:
Mailing address:
  • Phone: 207-290-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JULIE RACINE
Title or Position: EXECUTIVE DIRECTOR
Credential: PMHNP-BC
Phone: 207-290-1450