Provider Demographics
NPI:1295367803
Name:SEBASTICOOK VALLEY HEALTH
Entity Type:Organization
Organization Name:SEBASTICOOK VALLEY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-487-4000
Mailing Address - Street 1:447 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967-3707
Mailing Address - Country:US
Mailing Address - Phone:207-487-4000
Mailing Address - Fax:207-487-3204
Practice Address - Street 1:26 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4163
Practice Address - Country:US
Practice Address - Phone:207-368-5747
Practice Address - Fax:207-368-5483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEBASTICOOK VALLEY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health