Provider Demographics
NPI:1295427326
Name:KENNEBEC COMMUNITY INTEGRATION
Entity type:Organization
Organization Name:KENNEBEC COMMUNITY INTEGRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:LSWX
Authorized Official - Phone:207-649-7197
Mailing Address - Street 1:97 STONEY ACRES RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:ME
Mailing Address - Zip Code:04345-6641
Mailing Address - Country:US
Mailing Address - Phone:207-649-7197
Mailing Address - Fax:
Practice Address - Street 1:97 STONEY ACRES RD
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:ME
Practice Address - Zip Code:04345-6641
Practice Address - Country:US
Practice Address - Phone:207-649-7197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty