Provider Demographics
NPI:1972093011
Name:SEASIDE FAMILY HEALTH CARE LLC PA
Entity type:Organization
Organization Name:SEASIDE FAMILY HEALTH CARE LLC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SWIMM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:207-937-8254
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-0675
Mailing Address - Country:US
Mailing Address - Phone:207-502-9465
Mailing Address - Fax:207-937-8529
Practice Address - Street 1:155 SACO AVE STE 2A
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064-1600
Practice Address - Country:US
Practice Address - Phone:207-937-8254
Practice Address - Fax:207-937-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
MECNP101027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty