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General NPI Number Information
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NPI Number | 1811990757
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Entity Type | Organization
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Legal Business Name | COASTAL MANOR CORPORATION
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 20 W MAIN ST
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City | YARMOUTH
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State | ME
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Zip | 04096-8412
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Country | US
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Telephone | 207-846-5013
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Fax | 207-846-2252
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Provider Business Mailing Address
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Address Line | 20 W MAIN ST
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City | YARMOUTH
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State | ME
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Zip | 04096-8412
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Country | US
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Telephone | 207-846-5013
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Fax | 207-846-2252
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. OREY F GADWAY
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Credential |
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Telephone | 207-846-5013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 36175
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License Number State | ME
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