Provider Demographics
NPI:1508093048
Name:KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
Entity Type:Organization
Organization Name:KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
Other - Org Name:KVCAP HEALTHY FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-859-1565
Mailing Address - Street 1:97 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6339
Mailing Address - Country:US
Mailing Address - Phone:207-859-1565
Mailing Address - Fax:207-873-0158
Practice Address - Street 1:97 WATER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6339
Practice Address - Country:US
Practice Address - Phone:207-859-1565
Practice Address - Fax:207-873-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103990100Medicaid
ME103990102Medicaid