Provider Demographics
NPI:1841795127
Name:KNADA, PA
Entity type:Organization
Organization Name:KNADA, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:POOLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-941-0879
Mailing Address - Street 1:12 STILLWATER AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3984
Mailing Address - Country:US
Mailing Address - Phone:207-941-0879
Mailing Address - Fax:207-941-0880
Practice Address - Street 1:12 STILLWATER AVE STE 7
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3984
Practice Address - Country:US
Practice Address - Phone:207-941-0879
Practice Address - Fax:207-941-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty