NPIMap

Organization Active NPI

Kennebec Valley Community Action Program

  • Early Intervention Provider Agency
  • Waterville, ME
National Provider Identifier
1508093048
Registry record updated Jun 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
Practice address
97 Water St
Waterville, ME 04901-6339
Phone
(207) 859-1565
Fax
(207) 873-0158
NPI assigned
Jun 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2009

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

Authorized official

Name
Pat Kosma
Title
Chief Executive Officer
Phone
(207) 859-1565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X Primary

Addresses

Primary practice location

97 Water St
Waterville, ME 04901-6339

Mailing address

97 Water St
Waterville, ME 04901-6339
Phone (207) 859-1565

Other identifiers 2

IdentifierTypeStateIssuer
103990100MedicaidME
103990102MedicaidME

Other names 1

  • KVCAP Healthy Families Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kennebec Valley Community Action Program5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

97 Water St
Waterville, ME 04901
Phone (207) 859-1500

NPI Registry JSON

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

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244678400000",
    "number": "1508093048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 WATER ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049016339",
            "telephone_number": "207-859-1565",
            "fax_number": "207-873-0158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 WATER ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049016339",
            "telephone_number": "207-859-1565",
            "fax_number": "207-873-0158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEBEC VALLEY COMMUNITY ACTION PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-11",
        "last_updated": "2009-06-11",
        "status": "A",
        "authorized_official_last_name": "KOSMA",
        "authorized_official_first_name": "PAT",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "207-859-1565"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103990100",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103990102",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KVCAP Healthy Families",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterville, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.