NPIMap

Organization Active NPI

Katahdin Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Houlton, ME
National Provider Identifier
1376618546
Registry record updated Dec 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KATAHDIN VALLEY HEALTH CENTER
Practice address
59 Bangor St
Houlton, ME 04730-1740
Phone
(207) 528-2285
Fax
(207) 528-2880
NPI assigned
Nov 22, 2006
Last updated
Dec 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Claudette G Humphrey
Title
Ceo
Phone
(207) 528-2285

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

59 Bangor St
Houlton, ME 04730-1740

Mailing address

529 S Patten Rd
Patten, ME 04765-3007
Phone (207) 528-2285

Other identifiers 1

IdentifierTypeStateIssuer
168260104MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041130000688 ME Part B Supplier - Clinic/Group Practice 4880659903 Receives reassigned benefits from 82 practitioners
12 other NPIs on this enrollment
Practice locations: Ashland, ME; Patten, ME; Millinocket, ME; Lincoln, ME; Houlton, ME; Dover Foxcroft, ME; Brownville, ME
O20101106000058 ME Part A Provider - Federally Qualified Health Center (FQHC) 4880659903 Practice locations: Houlton, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376618546. Details of each certification follow.

Federally qualified health center certification: CCN 201852

Legal name
KATAHDIN VALLEY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 3, 2005
Last certification
Oct 3, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1974 in ME
Enrollment address
59 Bangor St
Houlton, ME 47301740
Related CCNs
201824

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rhonda R Brophy Individual Corporate Director Feb 17, 2010
Brandi Stevenson Individual Corporate DirectorTreasurer Nov 17, 2021
Kathy White Individual Corporate DirectorBoard Member Nov 23, 2022
Jason Parent Individual Corporate DirectorBoard Member Oct 27, 2021
Chris M Nickerson Individual Corporate Director May 25, 2008
Alicia Stone Individual Corporate DirectorBoard Member Oct 27, 2021
John Arthur Doe Individual Corporate Director Mar 30, 2005
Chad R Perkins Individual Corporate DirectorBoard Member Apr 27, 2016
Charity Rudge Individual W-2 Managing EmployeeChief Financial Officer Feb 1, 2025
Kathleen P Case Individual Corporate DirectorBoard Member Jan 29, 2014
Claudette G Humphrey Individual Corporate OfficerCeo Jul 31, 2016
W-2 Managing EmployeeCeo Jul 31, 2016

Practitioners & affiliated clinicians

Practitioners 108

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 108

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482192000000",
    "number": "1376618546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 S PATTEN RD",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "047653007",
            "telephone_number": "207-528-2285",
            "fax_number": "207-528-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 BANGOR ST",
            "city": "HOULTON",
            "state": "ME",
            "postal_code": "047301740",
            "telephone_number": "207-528-2285",
            "fax_number": "207-528-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATAHDIN VALLEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2016-12-20",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "CLAUDETTE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-528-2285"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168260104",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houlton, ME

Sources for this page

Verify at the official NPI Registry.