Provider Demographics
NPI:1952110678
Name:KATAHDIN VALLEY HEALTH CENTER
Entity type:Organization
Organization Name:KATAHDIN VALLEY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-538-3700
Mailing Address - Street 1:529 S PATTEN RD
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3007
Mailing Address - Country:US
Mailing Address - Phone:207-538-3700
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:5 LAKE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1420
Practice Address - Country:US
Practice Address - Phone:207-538-3700
Practice Address - Fax:207-528-2880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATAHDIN VALLEY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)