Provider Demographics
NPI:1851625834
Name:ST JOHN VALLEY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ST JOHN VALLEY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-728-7197
Mailing Address - Street 1:291 NEWBERRY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1219
Mailing Address - Country:US
Mailing Address - Phone:207-718-7197
Mailing Address - Fax:207-728-7550
Practice Address - Street 1:291 NEWBERRY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1219
Practice Address - Country:US
Practice Address - Phone:207-718-7197
Practice Address - Fax:207-728-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services