Provider Demographics
NPI:1134360795
Name:SEASIDE REALTY INC.
Entity type:Organization
Organization Name:SEASIDE REALTY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:VARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-375-6562
Mailing Address - Street 1:69 LISBON RD
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-4209
Mailing Address - Country:US
Mailing Address - Phone:207-375-6562
Mailing Address - Fax:207-375-6585
Practice Address - Street 1:69 LISBON RD
Practice Address - Street 2:
Practice Address - City:SABATTUS
Practice Address - State:ME
Practice Address - Zip Code:04280-4209
Practice Address - Country:US
Practice Address - Phone:207-375-6562
Practice Address - Fax:207-375-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS3015310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility