Katahdin Valley Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Ashland, ME
NPI 1962833624 · NPPES record last updated Dec 20, 2016
Key facts
- NPI
- 1962833624
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- KATAHDIN VALLEY HEALTH CENTER
- Practice address
- 33 Walker St
Ashland, ME 04732-3429 - Phone
- (207) 528-2285
- Fax
- (207) 528-2880
- NPI assigned
- Dec 6, 2013
- Organization subpart
- No
Authorized official
- Name
- Claudette G Humphrey
- Title
- Ceo
- Phone
- (207) 528-2285
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 12
Corporate family (same tax ID) 14
Practitioners 67
-
Debra D. Cobbeldick, P.A.
-
David H Flaherty, DMSC, PA-C
-
Nicki J Larrabee, FNP
-
Shannon Rene Stewart, CNP
-
Debra M Waddell, FNP-C
-
Ashley Martin Chabre, FNP
-
Heather L Duquette, APRN-CNP
-
Andrew Joehai Lam, DPM
-
Sarah V Allman, FNP
-
Alyssa Deem, PA-C
-
Kashana Taneshia Gaines, LCSW
-
Jean Hamlin, MD
-
Jonathan Thomas Huggins, PMHNP-BC
-
Ross Aaron Levesque, DPT
-
Jennifer Lindsay, D.C., R.T(R)
-
Alexandra Marcus, M.S., CCC-SLP
-
Beth Anne Martin, LMSW
-
Alexandria McDade I, MSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ME
Federally qualified health center certification: CCN 201911
- Legal name
- KATAHDIN VALLEY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 28, 2014
- Last certification
- Mar 28, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 12, 1974 in ME
- Enrollment address
- 33 Walker St
Ashland, ME 47323429
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Rhonda R Brophy |
Corporate Director |
Feb 17, 2010 | |
| Brandi Stevenson |
Corporate Director |
Nov 17, 2021 | |
| Kathy White |
Corporate Director |
Nov 23, 2022 | |
| Jason Parent |
Corporate Director |
Oct 27, 2021 | |
| Chris M Nickerson |
Corporate Director |
May 25, 2008 | |
| Alicia Stone |
Corporate Director |
Oct 27, 2021 | |
| John Arthur Doe |
Corporate Director |
Mar 30, 2005 | |
| Chad R Perkins |
Corporate Director |
Apr 27, 2016 | |
| Charity Rudge |
Corporate Officer |
Dec 1, 2020 | |
| W-2 Managing Employee |
Dec 1, 2020 | ||
| Kathleen P Case |
Corporate Director |
Jan 29, 2014 | |
| Claudette G Humphrey |
Corporate Officer |
Jul 31, 2016 | |
| W-2 Managing Employee |
Jul 31, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041130000688 | ME | Part B Supplier - Clinic/Group Practice | 4880659903 |
Receives reassigned benefits from 82 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ashland, ME; Patten, ME; Millinocket, ME; Lincoln, ME; Houlton, ME; Dover Foxcroft, ME; Brownville, ME |
| O20140317000169 | ME | Part a Provider - Federally Qualified Health Center (FQHC) | 4880659903 | Practice locations: Ashland, ME |
National Provider Directory
- Tax ID family
- Katahdin Valley Health Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
33 Walker St
Ashland, ME 04732-3429
Mailing address
529 S Patten Rd
Patten, ME 04765-3007
Phone (207) 528-2285
Other providers in Ashland, ME
- Tanya Clark
- Janice Cyr
- Eleanor Lury
- Chelsea Hammond
- Susan C Hoovler
- Kylee Lothrop
- Kelly Love
- Brittany Macfarline
- Msad#32
- Karen Oakes
All providers in Ashland, ME · Federally Qualified Health Center (FQHC) in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.