1720106362 NPI number — KENNEBEC VALLEY COMMUNITY ACTION PROGRAM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720106362 NPI number — KENNEBEC VALLEY COMMUNITY ACTION PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KVCAP FAMILY PLANNING OR KVCAP HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720106362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
97 WATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERVILLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04901-6339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-859-1638
Provider Business Mailing Address Fax Number:
207-859-1696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 WATER ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901-6339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-859-1638
Provider Business Practice Location Address Fax Number:
207-859-1696
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
COLLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
FPNP
Authorized Official Telephone Number:
207-859-1639

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  R013536 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 013238 . This is a "ANTHEM PROV. NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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