Provider Demographics
NPI:1558760140
Name:KENDALL COMMUNITY CASE MANAGEMENT AGENCY
Entity Type:Organization
Organization Name:KENDALL COMMUNITY CASE MANAGEMENT AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:207-853-4245
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:BERMAN MALL SUITE 3 64 WATER ST
Mailing Address - City:EASTPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04631-0185
Mailing Address - Country:US
Mailing Address - Phone:207-853-0693
Mailing Address - Fax:207-853-0694
Practice Address - Street 1:64 WATER ST
Practice Address - Street 2:BERMAN MALL SUITE 3
Practice Address - City:EASTPORT
Practice Address - State:ME
Practice Address - Zip Code:04631-1329
Practice Address - Country:US
Practice Address - Phone:207-853-0963
Practice Address - Fax:207-853-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEG9012 HI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management