Healthcare Provider Details

I. General information

NPI: 1164666996
Provider Name (Legal Business Name): KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 WATER ST WATERVILLE
WATERVILLE ME
04901-6339
US

IV. Provider business mailing address

97 WATER ST WATERVILLE
WATERVILLE ME
04901-6339
US

V. Phone/Fax

Practice location:
  • Phone: 207-859-1565
  • Fax:
Mailing address:
  • Phone: 207-859-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateME

VIII. Authorized Official

Name: MS. PAT KOSMAS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 207-859-1565