Healthcare Provider Details

I. General information

NPI: 1194428656
Provider Name (Legal Business Name): KATAHDIN VALLEY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 04/29/2023
Certification Date: 04/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 SUMMER ST STE A
DOVER FOXCROFT ME
04426-1129
US

IV. Provider business mailing address

529 S PATTEN RD
PATTEN ME
04765-3007
US

V. Phone/Fax

Practice location:
  • Phone: 207-528-2285
  • Fax: 207-528-2880
Mailing address:
  • Phone: 207-528-2285
  • Fax: 207-528-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CLAUDETTE HUMPHREY
Title or Position: CEO
Credential:
Phone: 207-528-2285