Provider Demographics
NPI:1841006053
Name:BROCK SEAL COVE LLC
Entity type:Organization
Organization Name:BROCK SEAL COVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESBROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-691-5059
Mailing Address - Street 1:19 GENERAL MOORE WAY
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1860
Mailing Address - Country:US
Mailing Address - Phone:207-667-9336
Mailing Address - Fax:
Practice Address - Street 1:19 GENERAL MOORE WAY
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1860
Practice Address - Country:US
Practice Address - Phone:207-667-9336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility