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General NPI Number Information
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NPI Number | 1164666996
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Entity Type | Organization
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Legal Business Name | KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 97 WATER ST WATERVILLE
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City | WATERVILLE
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State | ME
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Zip | 04901-6339
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Country | US
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Telephone | 207-859-1565
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Fax |
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Provider Business Mailing Address
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Address Line | 97 WATER ST WATERVILLE
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City | WATERVILLE
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State | ME
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Zip | 04901-6339
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Country | US
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Telephone | 207-859-1565
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. PAT KOSMAS
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Credential |
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Telephone | 207-859-1565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | ME
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