Provider Demographics
NPI:1902892771
Name:LEDGEVIEW NURSING HOME INC
Entity Type:Organization
Organization Name:LEDGEVIEW NURSING HOME INC
Other - Org Name:LEDGEVIEW LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:NEWELL
Authorized Official - Last Name:WILDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-674-2250
Mailing Address - Street 1:141 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:WEST PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04289-5227
Mailing Address - Country:US
Mailing Address - Phone:207-674-2250
Mailing Address - Fax:207-674-3101
Practice Address - Street 1:141 BETHEL RD
Practice Address - Street 2:
Practice Address - City:WEST PARIS
Practice Address - State:ME
Practice Address - Zip Code:04289-5227
Practice Address - Country:US
Practice Address - Phone:207-674-2250
Practice Address - Fax:207-674-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1966310400000X, 313M00000X, 314000000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME119390001Medicaid
ME119390000Medicaid
ME20-5125Medicare PIN