Organization
COASTAL MANOR CORPORATION
Active
Other names
Coastal Manor Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OREY F GADWAY (ADMINISTRATOR)
(207) 846-5013
Entity
Organization
Contact information
Practice address
20 W MAIN ST, YARMOUTH, ME 04096-8412
(207) 846-5013
(207) 846-2252
Mailing address
20 W MAIN ST, YARMOUTH, ME 04096-8412
(207) 846-5013
(207) 846-2252
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
36175
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040823
ANTHEM BC
ME
05
—
115010000
—
ME
01
—
141P10285
MEDICARE PART A
ME
01
—
205157
MEDICARE PTAN
ME
Enumeration date
05/24/2005
Last updated
07/21/2015
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