Provider Demographics
NPI:1699591974
Name:BROCK BAYVIEW LLC
Entity type:Organization
Organization Name:BROCK BAYVIEW 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 1:45 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEARSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04974-3501
Mailing Address - Country:US
Mailing Address - Phone:207-548-2415
Mailing Address - Fax:
Practice Address - Street 1:45 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974-3501
Practice Address - Country:US
Practice Address - Phone:207-548-2415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility