Provider Demographics
NPI:1366967812
Name:KENNEBEC VALLEY CASE MANAGEMENT SERVICE
Entity type:Organization
Organization Name:KENNEBEC VALLEY CASE MANAGEMENT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOTY
Authorized Official - Suffix:
Authorized Official - Credentials:LSX, BS, AA, MSP
Authorized Official - Phone:207-441-5637
Mailing Address - Street 1:309 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-1342
Mailing Address - Country:US
Mailing Address - Phone:207-441-5637
Mailing Address - Fax:
Practice Address - Street 1:309 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:ME
Practice Address - Zip Code:04330-1342
Practice Address - Country:US
Practice Address - Phone:207-441-5637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty